From the Guidelines
The first-line treatment for scabies is permethrin 5% cream, which should be applied to the entire body from the neck down, leaving it on for 8-14 hours (typically overnight) before washing off, as recommended by the 2015 sexually transmitted diseases treatment guidelines 1.
Treatment Approach
The treatment approach for scabies involves a combination of topical and oral medications, as well as measures to prevent reinfestation.
- Permethrin 5% cream is the preferred topical treatment, applied to the entire body from the neck down, and left on for 8-14 hours before washing off.
- A second application one week later is recommended to kill newly hatched mites.
- For severe cases or when permethrin fails, oral ivermectin can be used at a dose of 200 mcg/kg, repeated after 1-2 weeks, as suggested by the guidelines 1.
Prevention of Reinfestation
To prevent reinfestation, all household members and close contacts should be treated simultaneously, even if asymptomatic.
- Bedding, clothing, and towels should be washed in hot water and dried on high heat, or removed from body contact for at least 72 hours, as recommended by the guidelines 1.
- Fumigation of living areas is unnecessary.
Management of Symptoms
Itching may persist for 2-4 weeks after successful treatment due to a hypersensitivity reaction to dead mites.
- Antihistamines and topical steroids can help manage this itching.
Special Considerations
Crusted scabies, also known as Norwegian scabies, is an aggressive infestation that requires combination treatment with a topical scabicide and oral ivermectin, as recommended by the guidelines 1.
- Lindane should be avoided due to the risks of neurotoxicity with heavy applications or denuded skin.
From the FDA Drug Label
Permethrin Cream, 5% is indicated for the treatment of infestation with Sarcoptes scabiei (scabies).
DOSAGE AND ADMINISTRATION: SHAKE WELL BEFORE USE. In Scabies: Thoroughly massage into the skin of the whole body, from the chin down, paying particular attention to all folds and creases. A second application is advisable 24 hours later.
The treatment for scabies includes:
- Permethrin (TOP), as indicated by the FDA drug label 2
- Crotamiton (TOP), with a recommended application process:
- Massage into the skin from the chin to the toes, including folds and creases
- Apply under fingernails after trimming them short
- A second application is advisable 24 hours later
- Clothing and bed linen should be changed the next day
- A cleansing bath should be taken 48 hours after the last application, as stated in the FDA drug label 3
From the Research
Scabies Treatment Options
The treatment for scabies typically involves the use of topical or oral medications to kill the mites and relieve symptoms. Some of the most commonly used treatments include:
- Permethrin 5% cream, which is considered the first-line treatment for scabies 4, 5, 6
- Oral ivermectin, which is often used in cases where topical treatments are not effective or practical 4, 7, 8, 6
- Topical ivermectin, which has been shown to be effective in some studies 7, 8
- Crotamiton and benzyl benzoate, which can be used as second-line treatments 6
Treatment Regimens
Different treatment regimens have been studied, including:
- A single application of permethrin 5% cream, which can be effective in some cases 5
- Two applications of permethrin 5% cream, one week apart, which has been shown to be highly effective 4, 5
- A single dose of oral ivermectin, which can be effective in some cases, but may require a second dose for complete cure 4, 7
- Two doses of oral ivermectin, two weeks apart, which has been shown to be highly effective 4, 7
Special Considerations
In certain cases, such as crusted scabies or immunosuppression, a combination of topical and oral treatments may be necessary 6. Additionally, pregnant women and infants under 3 months of age may require special consideration when choosing a treatment 6. It is essential to follow the recommended treatment guidelines and consult with a healthcare professional to determine the best course of treatment for each individual case.