What is the diagnosis and treatment for scabies (sarcoptic mange)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Article Review Status
Submitted
Under Review
Approved

Last updated: April 11, 2025 • View editorial policy

From the Guidelines

Scabies treatment should involve a combination of topical scabicide and oral ivermectin for severe cases, particularly crusted scabies, with a recommended regimen of 5% topical permethrin cream applied daily for 7 days then 2 times weekly until discharge or cure, and oral ivermectin 200 ug/kg on days 1, 2, 8, 9, and 15, with additional doses on days 22 and 29 for severe cases 1. Scabies is a contagious skin condition caused by the microscopic mite Sarcoptes scabiei.

Treatment Approach

  • For severe cases, such as crusted scabies, combination treatment is recommended to ensure effective management and prevent treatment failure.
  • The use of 5% topical permethrin cream is preferred over other topical scabicides due to its efficacy and safety profile.
  • Oral ivermectin is also recommended for severe cases, with a dosing regimen of 200 ug/kg on specific days to ensure optimal treatment outcomes.

Management Considerations

  • Bedding and clothing should be decontaminated by machine-washing, machine-drying using the hot cycle, or dry cleaning, or removed from body contact for at least 72 hours to prevent re-infestation 2.
  • Fumigation of living areas is unnecessary, and persons with scabies should be advised to keep fingernails closely trimmed to reduce injury from excessive scratching.

Quality of Life

  • Itching may persist for 2-4 weeks after successful treatment due to the body's allergic response to the dead mites, and antihistamines or topical steroids can help manage this itching.
  • Scabies spreads through prolonged skin-to-skin contact, and common affected areas include finger webs, wrists, armpits, waistline, and genitals.
  • Without proper treatment, the infestation can continue indefinitely, highlighting the importance of prompt and effective treatment.

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. For eradication of scabies ( Sarcoptes scabiei) and for symptomatic treatment of pruritic skin.

  • Permethrin (TOP) and crotamiton (TOP) are indicated for the treatment of scabies.
  • The treatment of scabies with permethrin (TOP) involves applying the cream from the head to the soles of the feet and washing it off after 8 to 14 hours 3, 4.
  • Crotamiton (TOP) is also used for the eradication of scabies and symptomatic treatment of pruritic skin 5.
  • ONE APPLICATION OF PERMETHRIN is generally curative 4.

From the Research

Treatment Options for Scabies

  • Topical permethrin is considered the most effective treatment for scabies, with a cure rate of 61.8% to 87.2% in adult immunocompetent patients 6.
  • The application of 5% permethrin cream once daily for two consecutive days is more effective than a single application 6.
  • Topical ivermectin is also an effective treatment for scabies, with a cure rate of 63.1% to 84.2% at the 2-week and 4-week follow-up, respectively 7.
  • Permethrin 2.5% cream is also effective in treating scabies, with a cure rate of 65.8% to 89.5% at the 2-week and 4-week follow-up, respectively 7.

Comparison of Treatment Options

  • A study comparing the efficacy of 5% permethrin cream with 10% crotamiton cream found that permethrin was significantly superior, with a cure rate of 81.3% compared to 53.8% for crotamiton 8.
  • Another study found that topical lindane and crotamiton are inferior to permethrin, but appear equivalent to each other and benzyl benzoate, sulfur, and natural synergized pyrethrins 9.
  • Oral ivermectin is also an effective treatment for scabies, particularly in populations with endemic disease, and may reduce the prevalence of scabies at one year more than topical permethrin 9.

Application and Administration

  • The application of topical permethrin 5% cream to all external surfaces of the body, including the scalp and head, may be necessary in some cases, particularly in infants and older adults with scalp involvement 10.
  • The cream should be stored in the refrigerator and applied cold to the entire skin surface, left on for 24 hours, and repeated 7-10 days later 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

A new treatment regimen with permethrin in scabies.

Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia, 2018

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.