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Scabies (cont.)

Medical Treatment

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). This is stronger than the over-the-counter permethrin, which is used for head lice and will not cure scabies. Permethrin is generally safe for use in children as young as 2 months of age. An older medication called lindane (Kwell) is rarely used because it is not very safe in children and may cause neurotoxicity (dizziness, seizures). Permethrin cream is applied from the head to the bottom of the feet, paying special attention to skin folds and the webs between fingers and toes. The cream should be applied to clean, dry skin. For best results, clip and clean all fingernails and toenails. Permethrin is usually left on the skin for 10-14 hours and then washed off in the shower. It is best to apply permethrin at bedtime and then wash it off in the morning. Other prescription lotions and creams are available and are applied differently. Please be sure to follow the directions carefully for the product prescribed for you.

There is a prescription pill to treat scabies called ivermectin (Stromectol). Because permethrin cream is relatively safe and effective, the pill is not usually needed. Ivermectin is not used in small children or in women who are pregnant or breastfeeding.

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. 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.

Occasionally, the scratched skin may become infected, and sores may have pus or become red and warm. This is separate 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 re-infected or that the cream was not used appropriately. In some cases, the treatment is repeated after two weeks if symptoms have not gone away.