Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The first question affected people ask is how to get rid of scabies. The most commonly recommended treatment is a prescription cream which kills the mite. Anti-itch medications can help relieve symptoms while the cream is working.
The most commonly used medication is called 5% permethrin cream (Elimite and others). The 5% cream is stronger than the over-the-counter permethrin, which is used for head lice and which will not cure scabies. Permethrin is generally safe for use in children older than 2 months of age.
There is a prescription pill called ivermectin (Stromectol) that has been used to treat scabies, but it is not FDA-approved for this indication. Because permethrin
cream is relatively safe and effective, the pill is not usually needed.
Crusted scabies is hard to treat and may require several applications of lotions, use of ivermectin pills, and extensive skin care to treat the crusted skin.
All household members, sexual partners, and other close contacts should be treated at the same time regardless of whether or not they have symptoms. Anyone who has had skin-to-skin contact within the past month should be treated. If a child with scabies attends day care or a person is institutionalized (such as in a nursing home or prison), then staff and others in close contact with the person should be treated. It is best to treat everyone simultaneously to minimize the risk that untreated people will reinfest treated people.
Occasionally, the scratched skin may become infected, and sores may contain pus or become red and warm. This is a separate condition from scabies and is usually a bacterial infection. If this occurs, it is treated with an oral antibiotic or an antibiotic ointment applied to the area.
The itching and rash may last for up to two weeks after treatment. If the symptoms last longer, it is possible that the person has been reinfested or that the cream was not used appropriately. In some cases, the treatment is repeated after two weeks if symptoms have not gone away. A second course of treatment may be given in this setting.
Some scabies mites appear to be acquiring resistance to some creams or ointments.