Can you return to work with close contact after scabies treatment with ivermectin, when symptom-free?

Return to Work After Scabies Treatment

You can return to work after completing scabies treatment with ivermectin once you are symptom-free, but you should wait at least 24 hours after treatment before returning to work environments with close contact. 1, 2

Treatment Effectiveness Timeline

• Ivermectin (200 μg/kg orally) is an effective treatment for scabies, but requires a second dose 2 weeks after the first dose due to its limited ovicidal activity 3, 1
• Symptoms may persist for up to 2 weeks after successful treatment due to allergic reactions to the mites, even after the mites have been killed 1, 2
• A single dose of ivermectin has shown excellent efficacy as pre-emptive therapy in asymptomatic primary contacts of classical scabies cases 4

Return to Work Guidelines

• After treatment with ivermectin and resolution of symptoms, you can generally return to work with the following precautions:
  • Wait at least 24 hours after treatment before returning to work environments with close contact 1
  • Ensure all bedding and clothing have been decontaminated by machine washing and drying using hot cycles, dry cleaning, or removing from body contact for at least 72 hours 3, 1
  • Be aware that you may still experience some itching for up to 2 weeks after successful treatment, but this does not mean you are still contagious 2

Important Considerations

• All close contacts should be examined and treated simultaneously to prevent reinfestation 1, 2
• If you work in healthcare or with vulnerable populations, your facility may have specific protocols for return to work after scabies treatment 5
• For those with crusted (Norwegian) scabies, more aggressive treatment and longer isolation may be necessary 6

Common Pitfalls to Avoid

• Failing to complete the full treatment course, including the second dose of ivermectin after 2 weeks 3, 1
• Not treating all close contacts simultaneously, which can lead to reinfestation 2, 7
• Assuming that persistent itching means treatment failure - itching can continue for up to 2 weeks after successful treatment 1, 2
• Not properly decontaminating bedding and clothing, which can harbor mites 3, 1

When to Seek Further Medical Attention

• If symptoms worsen or new rashes develop after treatment 1
• If symptoms persist beyond 2-4 weeks after completing the full treatment course 2
• If close contacts develop symptoms of scabies 7