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.
Follow your doctor's instructions for prescription anti-scabies agents, if prescribed for you.
Do not apply to eyes, face, or mucous membranes.
Discuss treatment with your doctor if you are pregnant, breastfeeding, or you are treating your newborn or a toddler.
Common prescription agents for scabies
Permethrin 5% cream (Elimite) is the treatment of choice for scabies. Permethrin 5% cream is applied from the head to the bottom of the feet, paying special attention to skin folds, the groin area, 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.
Less common prescription agents
Lindane 1% cream or lotion is an older medication that is rarely used because it is not very safe in children and is potentially toxic to the nervous system (leading to symptoms such as dizziness,
seizures). Some scabies have become resistant to Lindane.
Ivermectin pill(s) (Stromectol) is an oral medication that is active against several parasites. It is not FDA-approved for use in scabies but has been used in cases with very heavy infestations. Ivermectin is not used in small children or in women who are pregnant or breastfeeding.
Malathion 0.5% lotion (Ovide) is usually used for head lice but has been used successfully to treat scabies. It is irritating to the skin. It must taken only as directed and should be kept out of the reach of children because ingestion may cause organophosphate poisoning.
Benzyl benzoate lotion is an older treatment for scabies. It can be irritating to the skin, especially in people who have eczema.
Crotamiton lotion or cream (Eurax) is approved for use in adults with scabies. Treatment failures with this drug are more common than with permethrin.
Sulfur-based lotions, creams, or soaps have been used, but are less effective than other options. They should not be used in people who are allergic to sulfa.