From the Guidelines
For scabies exposure treatment, I recommend permethrin 1% cream rinse or pyrethrins with piperonyl butoxide as the first-line treatment, as per the 2015 guidelines 1. Apply the cream or lotion to the affected areas and wash off after 10 minutes. It is essential to note that the provided evidence does not specify the exact duration of application or the need for a second application. However, based on general medical knowledge, a second application one week later may be necessary to kill newly hatched mites. For children under 2, it is crucial to exercise caution and consider alternative treatments or consult a healthcare professional. Alternative treatments may include ivermectin (oral medication), benzyl benzoate 25% lotion, or crotamiton 10% cream, although these are not specified in the provided evidence. All household members and close contacts should be treated simultaneously, even if asymptomatic, to prevent reinfestation. Wash all bedding, clothing, and towels used in the past 3 days in hot water and dry on high heat, as recommended in the 2015 guidelines 1. Items that cannot be washed should be sealed in plastic bags for at least 72 hours. Itching may persist for 2-4 weeks after successful treatment due to allergic reactions to dead mites, and retreating 2 weeks after the initial treatment regimen can be considered for those persons who are still symptomatic or when live mites are observed 1. Scabies spreads through prolonged skin-to-skin contact, with mites burrowing into the skin to lay eggs, making simultaneous treatment of all contacts crucial for breaking the transmission cycle. Some key considerations for management include:
- Decontaminating bedding and clothing
- Avoiding fumigation of living areas
- Keeping fingernails closely trimmed to reduce injury from excessive scratching 1
- Considering alternative regimens for those who do not respond initially to the recommended treatment 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. ONE APPLICATION IS GENERALLY CURATIVE.
For scabies exposure treatment, the recommended treatment is permethrin cream, 5%. The treatment involves thoroughly massaging the cream into the skin from the head to the soles of the feet and leaving it on for 8 to 14 hours before washing it off.
- Key points:
From the Research
Scabies Exposure Treatment
- Scabies is a skin infestation that affects over 200 million people worldwide, causing significant socioeconomic impact 3.
- The primary mode of transmission is through prolonged skin-to-skin contact, while fomite-mediated transmission is uncommon but can be significant in crusted scabies 3.
- Treatment options for scabies include:
- Topical permethrin 5% as first-line treatment, which is safe for use during pregnancy, lactation, and in children under 2 months 3, 4.
- Oral ivermectin as a first-line therapeutic alternative, which can be administered during lactation and is safe for children over 15kg 3, 4.
- Combination of permethrin and ivermectin for treating crusted scabies or intractable cases 4.
- Causes of treatment failure include:
- Improper application of external agents
- Failure of repeated treatment with ivermectin
- Incomplete decontamination of furnishings and clothes
- Failure to simultaneously treat contact persons
- Absence of written documents explaining treatment modalities
- Patient belonging to a risk group 4.
- There is a rising number of well-documented cases of poor response to permethrin, although there is no direct proof of resistance 4, 5.
- Moxidectin is a new substance undergoing clinical testing as a potential treatment for scabies 4.
- Mass drug administration of oral ivermectin is an effective option for managing scabies in communities with high prevalence or for scabies outbreaks in institutions 3, 6.