Dermatologic Manifestations of Scabies Medication

  • Author: Kelly M Cordoro, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Dec 9, 2009
 

Medication Summary

The mainstay of treatment is the application of topical antiscabietic agents, with repeat application in 7 days. An oral agent, ivermectin, is also available and effective.[11, 12]

Ivermectin is a synthetic macrocyclic lactone belonging to the avermectin group of antibiotics. It has no antibiotic activity but is active against a number of endoparasites and ectoparasites of humans and animals.[13] Ivermectin is effective in most cases of typical scabies at a dose of 200-250 mcg/kg given at diagnosis and repeated in 7-14 days. Crusted scabies may require 3 or more doses given at 1- to 2-week intervals. Ivermectin is an ideal agent in cases for which topical therapy is difficult or impractical, such as in widespread institutional infestations and bedridden patients.[12]

Ivermectin is contraindicated in patients with allergic sensitization or nervous system disorders and in women who are pregnant or breastfeeding. Children younger than 5 years or less than 15 kg should not be treated with ivermectin.

Symptomatic treatment may require oral antihistamines and topical antipruritics/anesthetics such as menthol (Sarna) and pramoxine (Prax). More severe symptoms may require a short course of topical or oral steroids. Secondary infections may require antibiotics and should be prescribed based on culture and sensitivity data.

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Scabicides/Antiparasitics

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Permethrin (Lyclear, Elimite)

 

Permethrin 5% cream is the drug of choice, especially for infants >2 mo and small children. More effective than crotamiton in treating symptoms and reducing chances of secondary bacterial infection. Even after successful treatment, postscabietic nodules and pruritus may persist for months.

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Lindane (Kwell)

 

In 1% lotion or cream. Stimulates nervous system of parasite, causing seizures and death. Previously standard treatment for scabies, but now considered second line, to be used if other agents fail or are not tolerated. Not very safe in children or neonates because of transcutaneous absorption leading to neurotoxicity. Overall, permethrin is a safer choice.

Precipitated sulfur in petrolatum

 

In 6% concentration.

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Crotamiton (Eurax)

 

A 10% cream or lotion for treatment of scabies. Mechanism of action unknown.

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Ivermectin (Stromectol)

 

Binds selectively with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death. Half-life is 16 h; metabolized in liver.

Available in 3- and 6-mg tab.

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Contributor Information and Disclosures
Author

Kelly M Cordoro, MD  Assistant Professor of Pediatric and Adult Dermatology, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Association of Professors of Dermatology, Dermatology Foundation, Medical Society of Virginia, National Psoriasis Foundation, Society for Pediatric Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Barbara B Wilson, MD  Edward P Cawley Associate Professor, Department of Dermatology, University of Virginia School of Medicine

Barbara B Wilson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Medical Society of Virginia, and Sigma Xi

Disclosure: Nothing to disclose.

Catharine Lisa Kauffman, MD, FACP  Georgetown Dermatology and Georgetown Dermpath

Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Royal Society of Medicine, Society for Investigative Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Hogan, MD  Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Haubrich WS. Medical Meanings: A Glossary of Word Origins. Philadelphia, Pa: American College of Physicians; 1997:200.

  2. Makigami K, Ohtaki N, Ishii N, Yasumura S. Risk factors of scabies in psychiatric and long-term care hospitals: a nationwide mail-in survey in Japan. J Dermatol. Sep 2009;36(9):491-8. [Medline].

  3. Mehta V, Balachandran C, Monga P, Rao R, Rao L. Images in clinical practice. Norwegian scabies presenting as erythroderma. Indian J Dermatol Venereol Leprol. Nov-Dec 2009;75(6):609-10. [Medline].

  4. Hay RJ. Scabies and pyodermas--diagnosis and treatment. Dermatol Ther. Nov-Dec 2009;22(6):466-74. [Medline].

  5. Svecova D, Chmurova N, Pallova A, Babal P. Norwegian scabies in immunosuppressed patient misdiagnosed as an adverse drug reaction. Epidemiol Mikrobiol Imunol. Aug 2009;58(3):121-3. [Medline].

  6. Phan A, Dalle S, Balme B, Thomas L. Scabies with clinical features and positive darier sign mimicking mastocytosis. Pediatr Dermatol. May-Jun 2009;26(3):363-4. [Medline].

  7. Bezold G, Lange M, Schiener R, et al. Hidden scabies: diagnosis by polymerase chain reaction. Br J Dermatol. Mar 2001;144(3):614-8. [Medline].

  8. Johnston G, Sladden M. Scabies: diagnosis and treatment. BMJ. Sep 17 2005;331(7517):619-22. [Medline].

  9. Karthikeyan K. Treatment of scabies: newer perspectives. Postgrad Med J. Jan 2005;81(951):7-11. [Medline].

  10. [Guideline] British Association for Sexual Health and HIV (BASHH). United Kingdom national guideline on the management of scabies infestation. National Guideline Clearinghouse. Feb 15 2008.

  11. Aubin F, Humbert P. Ivermectin for crusted (Norwegian) scabies. N Engl J Med. Mar 2 1995;332(9):612. [Medline].

  12. Huffam SE, Currie BJ. Ivermectin for Sarcoptes scabiei hyperinfestation. Int J Infect Dis. Jan-Mar 1998;2(3):152-4. [Medline].

  13. Elgart GW, Meinking TL. Ivermectin. Dermatol Clin. Apr 2003;21(2):277-82. [Medline].

  14. Lin S, Farber J, Lado L. A case report of crusted scabies with methicillin-resistant Staphylococcus aureus bacteremia. J Am Geriatr Soc. Sep 2009;57(9):1713-4. [Medline].

  15. Brodell RT, Helms SE. Bedside testing: the diagnostic cornerstone of dermatology. Compr Ther. Mar 1997;23(3):211-7. [Medline].

  16. Burgess I. Sarcoptes scabiei and scabies. Adv Parasitol. 1994;33:235-92. [Medline].

  17. Burkhart CG, Burkhart CN, Burkhart KM. An epidemiologic and therapeutic reassessment of scabies. Cutis. Apr 2000;65(4):233-40. [Medline].

  18. Fitzpatrick TB, Austen KF, Wolff K, et al, eds. Dertmatology in General Medicine. 4th ed. New York, NY: McGraw-Hill; 1993:1812-3.

  19. Elgart ML. Scabies. Dermatol Clin. Apr 1990;8(2):253-63. [Medline].

  20. Fitzpatrick TB, Johnson RA, Wolff K. Inset Bites and Infestations. In: Fitzpatrick TJ, Johnson RA, Wolff K, Polano MK, Suurmond R, eds. Color Atlas and Synopsis of Clinical Dermatology. 3rd ed. New York, NY: McGraw-Hill; 1997:836-61.

  21. Guldbakke KK, Khachemoune A. Crusted scabies: a clinical review. J Drugs Dermatol. Mar 2006;5(3):221-7. [Medline].

  22. McCarthy JS, Kemp DJ, Walton SF, Currie BJ. Scabies: more than just an irritation. Postgrad Med J. Jul 2004;80(945):382-7. [Medline].

  23. Molinaro MJ, Schwartz RA, Janniger CK. Scabies. Cutis. Dec 1995;56(6):317-21. [Medline].

  24. Orkin M, Maibach HI. Scabies treatment: current considerations. Curr Probl Dermatol. 1996;24:151-6. [Medline].

  25. Paller AS. Scabies in infants and small children. Semin Dermatol. Mar 1993;12(1):3-8. [Medline].

  26. Schleicher SM, Stewart P. Scabies: the mite that roars. Emerg Med. 1997;6:54-8.

 
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Scabies mite scraped from a burrow (original magnification, 400X).
A typical linear burrow on the flexor forearm. Courtesy of Kenneth E. Greer, MD.
A subtle linear burrow accompanied by erythematous papules on the sole of the foot in a child with scabies. Courtesy of Kenneth E. Greer, MD.
Erythematous papules and papulovesicles on the flexor wrist. Courtesy of Kenneth E. Greer, MD.
Scabies on the penile shaft and glans. Courtesy of William D. James, MD.
Scabietic papules on the penile shaft and scrotum. Courtesy of Kenneth E. Greer, MD.
Widespread eruption on the back of an infant with scabies. Courtesy of Kenneth E. Greer, MD.
Nodular scabies in an infant. Courtesy of Kenneth E. Greer, MD.
Nodular scabies. Courtesy of Kenneth E. Greer, MD.
Crusted scabies. Courtesy of William D. James, MD.
Crusted scabies. Courtesy of Kenneth E. Greer, MD.
Scabies preparation demonstrating a mite and ova. Courtesy of William D. James, MD.
Scabies. Erythematous vesicles and papules are present on torso extremities, some with adjacent linear excoriations.
In routine scabies, a single mite is seen. Eosinophilic spongiosis may be present (hematoxylin and eosin; original magnification, 400X).
Scabies mite in the stratum corneum. Courtesy of William D. James, MD.
In crusted scabies, sections show multiple mites (arrows) within the hyperkeratotic stratum corneum. The epidermis is spongiotic (hematoxylin and eosin; original magnification, 100X).
Scabies. Courtesy of William D. James, MD.
Scabies in the interdigital web spaces. Courtesy of William D. James, MD.
Papulovesicles and nodules on the palm in a patient with scabies. Courtesy of Kenneth E. Greer, MD.
 
 
 
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