What is the treatment for mites on the hands?

Treatment for Mites on the Hands

For scabies mites on the hands, apply topical permethrin 5% cream or take oral ivermectin, ensuring treatment of the entire body including hands, with a second application/dose 7-14 days later to kill newly hatched mites. 1, 2, 3

Diagnosis and Clinical Context

Before treating, confirm the diagnosis of scabies infestation:

• Look for characteristic burrows, pruritic papules, and excoriated lesions on finger web spaces, volar wrists, and lateral aspects of fingers 2, 4
• Scabies is transmitted through prolonged skin-to-skin contact, not casual contact 5, 2
• Persistent pruritus after treatment does not indicate treatment failure unless living mites are demonstrated after 14 days 1
• Consider demodex mites as an alternative diagnosis if the presentation is atypical, though these typically affect facial areas rather than hands 6

First-Line Treatment Options

Topical Permethrin 5% Cream (Gold Standard):

• Massage thoroughly into skin from head to soles of feet, including hands, finger webs, and under fingernails 1, 3
• Leave on for 8-14 hours before washing off 1
• Apply a second treatment 7-14 days later to kill mites that hatched after the first application 3, 4
• Treatment failure rate is approximately 10.8% 2

Oral Ivermectin (Effective Alternative):

• Particularly useful for patients who cannot apply topical treatments properly or in institutional outbreaks 3
• Requires a second dose 7-14 days after the first 5, 3
• Treatment failure rate is approximately 11.8% 2
• Week 2 clearance rates are similar to permethrin (68% vs 74%) 2

Critical Treatment Principles

Treat the entire body, not just the hands:

• Scabies mites burrow throughout the body, and hand-only treatment will fail 1, 3
• Include the scalp, face, hairline, neck, and temple in all patients, as these areas are commonly missed 1, 3
• Use approximately 30 grams of cream for an average adult 1

Simultaneous treatment of close contacts:

• All household members and close contacts must be treated simultaneously, even if asymptomatic 3, 4
• Failure to treat contacts is a common cause of treatment failure 3

Environmental Decontamination

Decontaminate fomites to prevent reinfestation:

• Place all clothing, bedding, and linens in a dryer on high heat for 10 minutes 3
• Vacuum furniture and carpets thoroughly 3
• Isolate non-launderable items for minimum 2 days (or 3 weeks for rigorous approach) 3
• Mites cannot survive off human skin for extended periods 5

Common Pitfalls to Avoid

Application errors are the most common cause of treatment failure:

• Not treating the face, scalp, and under fingernails 3
• Applying treatment only to visible lesions rather than entire body 1, 3
• Failing to reapply medication at day 7-14 3
• Not treating close contacts simultaneously 3
• Inadequate decontamination of clothing and bedding 3

When to Retreat

• Demonstrable living mites after 14 days indicate retreatment is necessary 1
• Persistent itching alone is not an indication for retreatment, as pruritus can persist for weeks after successful mite eradication 1
• If treatment failure occurs, ensure proper application technique before switching medications 3