Template:Scabies treatment

General Care

  • Wash all linens/clothes in hot water or bag bulky items and keep sealed for 2wks
  • Pruritus may continue for weeks despite successful elimination of infestation
    • Consider steroids for symptom relief

Adults

  • Permethrin 5% cream for all family members[1]
    • Apply from neck down
    • Leave on for 8-12hr before washing off
    • Has 95-98% success rate, may reapply in 1-2wks if incomplete effect
  • Ivermectin 200 mcg/kg may be necessary for severe infection
    • Also viable option in adolescent or adult with insecure social situation
    • Success rate 70%, increases if give repeat dose 2wks after
    • Contraindicated in lactating women and children < 15kg

Infants

  • Permethrin 5% is FDA approved for > 2 months of age although still recommended for neonatal scabies[2]
    • May require application head to toe (avoid mucus membranes)
    • Leave on for 8-12 hours, then wash off

Avoid

  • Lindane - effective treatment but associated with potential for toxic manifestations (seizures, neurotoxicity)
    • Reserved for refractory cases
  • Strong M. Johnstone P. Interventions for treating scabies. Cochrane Database Syst Rev. 2007;(3):CD000320
  • Subramaniam S. Rutman MS. Wnger JK. A papulopustular, vesicular, crusted rash in a 4-week old neonate. Pediatric Emergency Care. 2013;29:1210-1212