When can a patient with scabies, who has received two applications of permethrin (5% lotion or cream), be considered for return to the general ward?

Management of Scabies Patient Return to General Ward After Permethrin Treatment

A patient with scabies who has received two applications of 5% permethrin lotion can return to the general ward after the second treatment is complete, as one application is generally curative and the second application provides additional assurance of treatment success. 1

Treatment Efficacy and Protocol

• 5% permethrin cream is the first-line treatment for uncomplicated scabies, applied to all areas of the body from the neck down and washed off after 8-14 hours 2, 1
• One application of permethrin is generally considered curative according to FDA labeling, though a second application is often recommended to ensure complete eradication 1
• The second application of permethrin provides additional assurance against treatment failure, with two applications showing cure rates of up to 96.9% 3

Return to General Ward Considerations

• After completing the second application of permethrin and allowing the appropriate contact time (8-14 hours), the patient can return to the general ward 2, 1
• No specific waiting period is mandated after the second treatment before returning to general population, as the treatment itself renders the patient non-infectious 2
• Patients may continue to experience pruritus (itching) for up to 2 weeks after successful treatment, which is rarely a sign of treatment failure and not an indication for retreatment or continued isolation 2, 1

Environmental Management

• Before returning the patient to the general ward, ensure that:
  • All bedding and clothing used by the patient have been decontaminated by machine washing/drying using hot cycle, dry cleaning, or removed from body contact for at least 72 hours 2, 4
  • The patient has been provided with fresh, clean clothing and bedding after treatment 2

Follow-Up Considerations

• Monitor the patient for persistent symptoms beyond 2 weeks, which may indicate treatment failure 2
• If live mites are observed after 14 days, retreatment would be necessary 1
• Common causes of treatment failure include:
  • Inadequate application of the permethrin cream 2
  • Reinfection from untreated contacts 2, 4
  • Possible permethrin resistance (though uncommon) 5

Special Considerations

• If the patient has crusted (Norwegian) scabies, a more intensive treatment regimen would be required before returning to the general ward 2, 4
• For immunocompromised patients, closer monitoring may be necessary as they are at increased risk for treatment failure 6