What is the recommended treatment dose for scabies in a 27-year-old female?

Scabies Treatment for a 27-Year-Old Female

For a 27-year-old female with scabies, apply permethrin 5% cream to all areas of the body from the neck down and wash off after 8-14 hours—this single application is generally curative. 1

First-Line Treatment Regimen

Permethrin 5% cream is the recommended first-line treatment, with approximately 30 grams sufficient for an average adult. 1 The application technique is critical:

• Apply thoroughly to all skin surfaces from the neck down, including under fingernails 2
• Leave on for 8-14 hours (typically applied before bedtime and washed off in the morning) 3, 1
• One application is generally curative 1
• For a 27-year-old woman, scalp treatment is typically unnecessary unless she is immunocompromised 1

Alternative First-Line Option: Oral Ivermectin

Oral ivermectin 200 μg/kg body weight is an equally effective first-line option, particularly useful for patients who prefer oral therapy or have difficulty with topical application. 2

• Take with food to increase bioavailability 2, 4
• Repeat the dose after 2 weeks to address eggs that may have hatched 2
• No dosage adjustment needed for renal impairment 4

Alternative Treatments (If First-Line Options Unavailable)

If permethrin or ivermectin are not available, consider:

• Lindane 1%: Apply 1 oz of lotion or 30 g of cream thinly from neck down, wash off after 8 hours 3

  • Critical contraindications: Do NOT use after bathing, in pregnant/lactating women, or with extensive dermatitis due to seizure risk 3, 2
  • Resistance has been reported in some U.S. regions 3

• Sulfur 6% ointment: Apply nightly for 3 consecutive nights, washing off previous applications before reapplying, then wash off 24 hours after the final application 3

Essential Management Steps

Environmental decontamination is mandatory to prevent reinfection:

• Machine wash and dry all bedding and clothing using hot cycle, or dry clean 2, 5
• Alternatively, remove items from body contact for at least 72 hours 3, 2
• Fumigation of living areas is unnecessary 3, 2

Contact management is critical for cure:

• Examine and treat all sexual partners, household contacts, and close personal contacts from the preceding month 2, 5
• All contacts must be treated simultaneously to prevent reinfection 2

Follow-Up and Expected Course

Pruritus commonly persists for up to 2 weeks after successful treatment and does not indicate treatment failure. 1, 2

• Reassess at 2 weeks if symptoms persist 2
• Retreatment is indicated only if live mites are demonstrated after 14 days 1
• Consider alternative regimen if no improvement after 2 weeks with documented live mites 2

Common Pitfalls to Avoid

• Inadequate application: Must cover ALL skin from neck down, including between fingers and toes 2
• Failure to treat contacts simultaneously: This is the most common cause of treatment failure 2
• Premature retreatment: Persistent itching for 1-2 weeks is normal and not a treatment failure 1, 2
• Using lindane after bathing: This increases absorption and seizure risk 3, 2
• Forgetting the second ivermectin dose: If using oral ivermectin, the 2-week repeat dose is essential 2

Special Considerations for This Patient

Since this is a 27-year-old female of reproductive age:

• If pregnant or lactating, permethrin 5% cream remains the preferred treatment 3, 5
• Avoid lindane entirely if pregnant or lactating 3
• Screen for other sexually transmitted infections if sexual transmission is suspected 6