What is the recommended treatment for scabies (scabiosis)?

Treatment of Scabies (Scabiosis)

The first-line treatment for scabies is permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8-14 hours, or oral ivermectin 200 μg/kg repeated in 2 weeks. 1, 2

First-Line Treatment Options

• Permethrin 5% cream: Apply to all areas of the body from the neck down and wash off after 8-14 hours 3, 1

  • FDA-approved for treatment of scabies 4
  • Effective, safe, and less expensive than ivermectin 3
  • Preferred for infants, young children, and pregnant/lactating women 1, 2

• Oral ivermectin: 200 μg/kg orally, repeated in 2 weeks 3, 1

  • Should be taken with food to increase bioavailability 3
  • Has limited ovicidal activity, requiring a second dose after 2 weeks 3
  • Not recommended for children weighing less than 15 kg 2

Alternative Treatment Option

• Lindane (1%): 1 oz of lotion or 30 g of cream applied thinly to all areas from the neck down and washed off after 8 hours 3
  • Should only be used if patients cannot tolerate first-line therapies or if these have failed 3
  • Contraindications: children <10 years, pregnant/lactating women, persons with extensive dermatitis 3, 1
  • Risks include seizures, aplastic anemia, and resistance in some areas 3

Management of Crusted (Norwegian) Scabies

• Combination therapy is recommended: 3, 2
  • Topical 5% permethrin cream applied daily for 7 days, then twice weekly until cure
  • PLUS oral ivermectin 200 μg/kg on days 1,2,8,9, and 15
  • Additional ivermectin on days 22 and 29 may be required for severe cases 3

Environmental Management

• Decontaminate bedding and clothing: 3, 1
  • Machine wash and dry using hot cycle, dry clean, or
  • Remove from body contact for at least 72 hours
• Fumigation of living areas is unnecessary 3
• Keep fingernails closely trimmed to reduce injury from scratching 3

Management of Contacts

• All persons with sexual, close personal, or household contact within the preceding month should be examined and treated 1, 2
• Treat all contacts simultaneously to prevent reinfection 1

Follow-Up and Expected Course

• Rash and pruritus may persist for up to 2 weeks after successful treatment 3
• Consider retreatment if symptoms persist beyond 2 weeks or if live mites are observed 3, 1
• Reasons for treatment failure include: 3, 1
  • Resistance to medication
  • Faulty application of topical scabicides
  • Failure to treat all contacts
  • Reinfection from untreated contacts or fomites
  • Cross-reactivity with other household mites

Treatment Efficacy Comparison

• Two applications of permethrin with a one-week interval is more effective (96.9% cure rate) than a single dose of ivermectin (62.4% cure rate) 5
• Two doses of ivermectin is comparable in efficacy (92.8% cure rate) to permethrin 5
• Permethrin-treated patients tend to recover earlier 5

Special Considerations

• Pregnancy and lactation: Permethrin is the preferred treatment 1, 2
• Children: Permethrin is recommended for infants and young children 1, 2
• Secondary bacterial infections: Consider combination therapy with permethrin 5% and fusidic acid 2% cream for impetiginized scabies 6