From the Guidelines
Scabies treatment should involve a combination of topical and oral medications, with permethrin 5% cream and oral ivermectin 200 ug/kg being the preferred treatment options, as recommended by the 2015 MMWR Recommendations and Reports 1. Scabies is a contagious skin condition caused by the Sarcoptes scabiei mite that burrows into the skin, causing intense itching, especially at night.
Treatment Options
- For crusted scabies, a combination treatment is recommended with a topical scabicide, either 5% topical benzyl benzoate or 5% topical permethrin cream, and treatment with oral ivermectin 200 ug/kg on days 1,2,8,9, and 15, as stated in the 2015 MMWR Recommendations and Reports 1.
- Additional ivermectin treatment on days 22 and 29 might be required for severe cases, as suggested by the same report 1.
- Lindane should be avoided because of the risks for neurotoxicity with heavy applications or denuded skin, as warned by the 2015 MMWR Recommendations and Reports 1.
Management Considerations
- Bedding and clothing should be decontaminated (i.e., either machine-washed, machine-dried using the hot cycle, or dry cleaned) or removed from body contact for at least 72 hours, as recommended by the 2015 MMWR Recommendations and Reports 1.
- Fumigation of living areas is unnecessary, as stated in the same report 1.
- Persons with scabies should be advised to keep fingernails closely trimmed to reduce injury from excessive scratching, as suggested by the 2015 MMWR Recommendations and Reports 1.
From the FDA Drug Label
Permethrin Cream, 5% is indicated for the treatment of infestation with Sarcoptes scabiei (scabies). Thoroughly massage Permethrin Cream, 5% into the skin from the head to the soles of the feet. For eradication of scabies ( Sarcoptes scabiei) and for symptomatic treatment of pruritic skin.
- Permethrin (TOP) and crotamiton (TOP) are indicated for the treatment of scabies.
- The treatment of scabies with permethrin (TOP) involves applying the cream from the head to the soles of the feet and washing it off after 8 to 14 hours 2, 2.
- Crotamiton (TOP) is also used for the eradication of scabies and symptomatic treatment of pruritic skin 3.
- ONE APPLICATION OF PERMETHRIN is generally curative 2.
From the Research
Treatment Options for Scabies
- Topical permethrin is considered the most effective treatment for scabies, with a cure rate of 61.8% to 87.2% in adult immunocompetent patients 4.
- The application of 5% permethrin cream once daily for two consecutive days is more effective than a single application 4.
- Topical ivermectin is also an effective treatment, with a cure rate of 63.1% to 84.2% at the 2-week and 4-week follow-up, respectively 5.
- Oral ivermectin may reduce the prevalence of scabies at one year in populations with endemic disease more than topical permethrin 6.
Application and Administration
- The current guidelines and medication labels instruct application of topical permethrin 5% cream from neck down for treatment of adult patients with scabies 7.
- However, there are cases where scalp-to-toes application of permethrin may be necessary, such as in infants or patients with scalp involvement 7.
- The cream should be stored in a refrigerator and applied cold to the entire skin surface, left on for 24 hours 4.
Comparison of Treatments
- Topical permethrin appears to be more effective than oral ivermectin, topical crotamiton, and topical lindane 5, 8.
- Topical permethrin also appears to be more effective in reducing itch persistence than either crotamiton or lindane 8.
- No significant difference was detected in the number of treatment failures between crotamiton and lindane, lindane and sulfur, benzyl benzoate and sulfur, and benzyl benzoate and natural synergized pyrethrins 8.