From the Guidelines
Home treatment for scabies involves applying prescription medications like permethrin 5% cream to the entire body from neck down, leaving it on for 8-14 hours before washing off, as recommended by the most recent guidelines 1. To effectively manage scabies at home, it is essential to combine medication with environmental decontamination and personal hygiene practices.
- All household members and close contacts should be treated simultaneously, even if they don't have symptoms, to prevent reinfestation.
- Bedding, clothing, and towels used in the past 3 days should be washed in hot water and dried on high heat, as suggested by the guidelines 1.
- Vacuuming carpets and furniture thoroughly can also help reduce the risk of reinfection.
- For symptom relief, antihistamines like diphenhydramine (Benadryl) can be taken for itching, and moisturizers can be used after treatment.
- Itching may persist for 2-4 weeks after successful treatment due to allergic reactions to dead mites.
- A second treatment is often recommended 7-10 days after the first to kill newly hatched mites, as noted in the management of scabies guidelines 1.
- If symptoms persist beyond 4 weeks or worsen, medical attention is necessary, as this may indicate treatment failure or reinfection. The guidelines also emphasize the importance of keeping fingernails closely trimmed to reduce injury from excessive scratching 1. Overall, treating all close contacts and decontaminating the environment are crucial steps in preventing reinfestation and ensuring effective home treatment for scabies.
From the FDA Drug Label
Permethrin Cream, 5% is indicated for the treatment of infestation with Sarcoptes scabiei (scabies). DOSAGE AND ADMINISTRATION: SHAKE WELL BEFORE USE. In Scabies: Thoroughly massage into the skin of the whole body, from the chin down, paying particular attention to all folds and creases. A second application is advisable 24 hours later. For scabies home treatment, the following topical treatments can be used:
- Permethrin (TOP): indicated for the treatment of scabies infestation 2
- Crotamiton (TOP): apply thoroughly to the skin from the chin to the toes, including folds and creases, with a second application 24 hours later 3 Key steps for home treatment with crotamiton (TOP) include:
- Massaging the lotion into the skin from the chin to the toes
- Applying lotion under fingernails after trimming them short
- Changing clothing and bed linen the next day
- Taking a cleansing bath 48 hours after the last application
From the Research
Scabies Home Treatment Options
- Topical permethrin is considered the most effective treatment for classic scabies 4
- Other treatment options include topical lindane, crotamiton, benzyl benzoate, sulfur, and natural synergized pyrethrins, although they are inferior to permethrin 4
- Oral ivermectin is also an effective treatment, especially in populations with endemic disease 4, 5
Comparison of Treatment Efficacy
- A study comparing topical ivermectin and permethrin 2.5% cream found that both treatments were effective, with cure rates of 84.2% and 89.5% at 4-week follow-up, respectively 5
- Another study found that 5% permethrin cream was significantly more effective than 10% crotamiton cream, with cure rates of 81.3% and 53.8%, respectively 6
- A comparative study of topical permethrin, crotamiton, and sulfur ointment found that permethrin had a faster improvement rate and a higher cure rate at 2-week follow-up 7