Can a 28-week pregnant individual use Gamma Benzene Hexachloride (GBH) lotion for scabies treatment?

Treatment of Scabies in a 28-Week Pregnant Woman

Pregnant women should NOT use Gamma Benzene Hexachloride (GBHA/lindane) lotion for scabies treatment, but should instead use permethrin 5% cream as the first-line treatment. 1

Recommended Treatment Options for Pregnant Women

First-Line Treatment

• Permethrin cream (5%) applied to all areas of the body from the neck down and washed off after 8-14 hours 1
  • Permethrin is effective, safe, and specifically recommended for pregnant women
  • Has minimal systemic absorption, making it safer for use during pregnancy

Alternative Treatment

• Crotamiton (10%) applied to the entire body from the neck down, nightly for 2 consecutive nights, and washed off 24 hours after the second application 1

Contraindicated Treatment

• Lindane (GBHA) lotion or cream should NOT be used in pregnant women due to potential neurotoxicity and risk of systemic absorption 1, 2
  • The CDC guidelines explicitly state that lindane should not be used by pregnant or lactating women 1
  • Lindane has been associated with seizures and aplastic anemia in some cases 1

Safety Evidence

• A retrospective matched cohort study found no evidence of adverse effects on pregnancy outcomes with permethrin 4% treatment during pregnancy 3
• Permethrin has less potential for toxicity compared to lindane, even in the event of inappropriate use 1
• Topical medications generally have limited systemic absorption, making permethrin a safer choice for pregnant women 4

Additional Management Considerations

• Bedding and clothing should be decontaminated by machine washing or drying using hot cycle (or dry-cleaning) or removed from body contact for at least 72 hours 1
• Sexual partners and close household contacts within the last month should be examined and treated simultaneously to prevent reinfestation 1
• Pruritus (itching) may persist for several weeks after successful treatment and does not necessarily indicate treatment failure 1

Follow-Up

• If symptoms persist after 1-2 weeks, re-evaluation may be necessary 1
• Some experts recommend re-treatment after one week if symptoms persist, while others recommend re-treatment only if live mites are observed 1
• If the initial treatment fails, switching to the alternative treatment regimen (crotamiton) is recommended 1

Common Pitfalls to Avoid

• Do not use lindane (GBHA) in pregnant women under any circumstances 1
• Do not assume that persistent itching after treatment necessarily indicates treatment failure, as this can continue for up to 2 weeks after successful treatment 1
• Avoid bathing immediately before applying scabies treatments, as this can increase systemic absorption 1
• Ensure complete application of the medication to all skin areas from the neck down (not just visibly affected areas) for effective treatment 1