What is the recommended treatment for a 10-year-old with scabies?

Treatment for a 10-Year-Old with Scabies

Treat with permethrin 5% cream applied to all areas of the body from the neck down (including scalp, hairline, neck, temple, and forehead in this age group), left on for 8-14 hours, then washed off—one application is generally curative. 1, 2, 3

First-Line Treatment

• Permethrin 5% cream is the recommended first-line treatment for uncomplicated scabies in a 10-year-old child 1, 2, 4
• Apply approximately 30 grams thoroughly massaged into the skin from head to soles of feet 3
• In children, treat the scalp, hairline, temple, and forehead as these areas are commonly infested in pediatric patients (unlike adults where scalp is rarely involved) 3
• Leave on for 8-14 hours before washing off with shower or bath 1, 3
• One application is generally curative 4, 3

Alternative Treatment Option

• Oral ivermectin 200 μg/kg can be used as an alternative first-line option, taken with food to increase bioavailability, with a second dose repeated after 2 weeks 1, 2, 4
• Ivermectin is safe and effective in children over 15 kg body weight 4
• For a 10-year-old (typically >15 kg), ivermectin is appropriate if topical therapy is impractical or has failed 1, 4

Critical Treatment Pitfalls to Avoid

• Do NOT use lindane in this 10-year-old patient—it is contraindicated in children under 10 years due to risk of neurotoxicity and seizures 1, 2, 4
• Avoid applying lindane after bathing, as this increases absorption and seizure risk 5, 2
• Do not apply permethrin to eyes; flush immediately with water if accidental contact occurs 3

Contact Management (Essential for Cure)

• Examine and treat all household members, close personal contacts, and anyone with contact in the preceding month simultaneously, even if asymptomatic 1, 2, 4
• Failure to treat contacts simultaneously is a leading cause of treatment failure and reinfection 2

Environmental Decontamination

• Machine wash and dry all bedding, clothing, and towels using hot cycle, or dry-clean, or remove from body contact for at least 72 hours 1, 2, 4
• Fumigation of living areas is unnecessary 1, 2
• Keep fingernails closely trimmed to reduce injury from scratching 2

Follow-Up and Expected Course

• Pruritus and rash may persist for up to 2 weeks after successful treatment—this is NOT treatment failure and does NOT require retreatment 1, 2, 4
• Approximately 75% of patients with persistent itching at 2 weeks will have resolution by 4 weeks 3
• Consider retreatment only if symptoms persist beyond 2 weeks OR live mites are observed 1, 2, 4
• Demonstrable living mites after 14 days indicate retreatment is necessary 3

When to Consider Treatment Failure

Reasons for persistent symptoms include:

• Inadequate application of topical treatment (most common) 2
• Reinfection from untreated contacts or contaminated fomites 2, 4
• True medication resistance (rare with permethrin) 2
• Cross-reactivity with other household mites 2, 4

Special Considerations for This Age Group

• Permethrin is particularly safe and effective in pediatric patients 2 months and older 4, 3
• The 10-year-old age makes this patient ineligible for lindane but ideal for either permethrin or ivermectin 1, 2, 4
• Treatment may temporarily exacerbate pruritus, edema, and erythema—this is expected and not a reason to discontinue 3