From the Guidelines
Scabies treatment should prioritize the use of permethrin 5% cream or oral ivermectin, with consideration of combination therapy for severe or crusted scabies, as recommended by the 2015 sexually transmitted diseases treatment guidelines 1. The first-line treatment for scabies is permethrin 5% cream, applied from neck to toes and left on for 8-14 hours before washing off, with a repeat application after 7 days. Alternatively, oral ivermectin can be used at a dose of 200 mcg/kg, with a second dose given 7-14 days later. For severe or crusted scabies, combination treatment with a topical scabicide, such as 5% topical permethrin cream, and oral ivermectin is recommended, with the oral ivermectin dose repeated on days 1,2,8,9, and 15, and potentially on days 22 and 29 for severe cases 1. It is essential to treat all household members and close contacts simultaneously, even if they do not have symptoms, to prevent reinfestation 1. Additionally, clothing, bedding, and towels used in the 3 days before treatment should be washed in hot water and dried on high heat, or removed from body contact for at least 72 hours 1. Itching may persist for 2-4 weeks after successful treatment due to an allergic reaction to the dead mites, and antihistamines or topical steroids can help manage this itching. Key considerations in scabies treatment include:
- Decontamination of bedding and clothing
- Trimming of fingernails to reduce injury from excessive scratching
- Examination and treatment of sex partners and household contacts who have had close contact with the patient within the month preceding scabies infestation 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Adults and children Thoroughly massage Permethrin Cream, 5% into the skin from the head to the soles of the feet. ONE APPLICATION IS GENERALLY CURATIVE. Demonstrable living mites after 14 days indicate that retreatment is necessary. INDICATIONS AND USAGE Permethrin Cream, 5% is indicated for the treatment of infestation with Sarcoptes scabiei (scabies).
The recommended treatment for scabies is to apply Permethrin Cream, 5% from the head to the soles of the feet, with one application generally being curative 2. The cream should be left on for 8 to 14 hours before being washed off 2. If living mites are still present after 14 days, retreatment may be necessary 2. Permethrin Cream, 5% is indicated for the treatment of scabies 2.
From the Research
Treatment Options for Scabies
- Topical permethrin 5% cream is considered an effective treatment for scabies, applied once daily, and can be used in adult immunocompetent patients 3.
- Oral ivermectin is another first-line therapeutic alternative, which can be administered during lactation and is safe in children >15kg 4.
- Mass drug administration of oral ivermectin is an excellent option for the management of scabies in communities with high prevalence or for scabies outbreaks in institutions 4.
Application and Efficacy of Permethrin
- Permethrin 5% cream should be applied to all external surfaces of the body, including the scalp and head, for effective treatment of scabies 5.
- A study comparing the efficacy of permethrin 5% vs. oral ivermectin found that two applications of permethrin with a one-week interval was more effective than a single dose of ivermectin 6.
- Another study comparing topical ivermectin vs. permethrin 2.5% cream found that two applications of ivermectin was as effective as two applications of permethrin 2.5% cream at the 2-week follow-up 7.
Comparison of Treatment Regimens
- A study comparing the treatment regimens of permethrin found that applying 5% permethrin cream once daily for two consecutive days is more effective than a single application in adult immunocompetent patients with scabies 3.
- The efficacy of permethrin 5% vs. oral ivermectin was compared, and it was found that two applications of permethrin with a one-week interval was effective in 96.9% of patients, while a single dose of ivermectin provided a cure rate of 62.4% 6.