Duration of Exclusion from Work or School for Scabies
Individuals with scabies should stay away from work or school until at least 24 hours after starting appropriate treatment. 1, 2
Treatment Recommendations
- First-line treatment is topical 5% permethrin cream applied to all areas of the body from the neck down and washed off after 8-14 hours 1
- Oral ivermectin (200 μg/kg, repeated in 2 weeks) is an effective alternative, particularly for patients who cannot tolerate topical therapy 1
- Permethrin is preferred for pregnant/lactating women and young children 2
- Lindane should be avoided in children <10 years, pregnant women, and persons with extensive dermatitis due to risk of neurotoxicity 1
Environmental Management
- Bedding and clothing should be decontaminated by machine washing/drying using hot cycle, dry cleaning, or removing from body contact for at least 72 hours 3, 1
- Fumigation of living areas is unnecessary 3, 1
Special Considerations for Return to Work/School
Standard Cases
- After starting appropriate treatment, individuals can return to work or school after 24 hours 1
- The National Collegiate Athletic Association (NCAA) requires evidence of a negative microscopic skin preparation before return to practice or competition 3
Crusted (Norwegian) Scabies
- Requires more aggressive treatment with combination therapy (topical permethrin plus oral ivermectin) 1, 2
- May require longer exclusion period due to higher contagiousness 4
Management of Contacts
- All persons with close personal, sexual, or household contact within the preceding month should be examined and treated if infested 3, 1
- Sexual contact should be avoided until patients and partners have been treated 3
Follow-Up Considerations
- Rash and pruritus may persist for up to 2-4 weeks after successful treatment 1, 4
- Consider retreatment after 2 weeks if symptoms persist or live mites are observed 1
Common Pitfalls to Avoid
- Failure to treat all close contacts simultaneously 1, 5
- Inadequate application of topical treatments 1
- Not repeating ivermectin dose after 2 weeks 1
- Expecting immediate resolution of symptoms (pruritus may persist for weeks) 1, 4
- Failure to decontaminate bedding and clothing 3, 1
Remember that while the person is no longer contagious after 24 hours of appropriate treatment, symptoms may persist for several weeks and should not be used as the basis for continued exclusion from work or school 1, 4.