Scabies Organism-Specific Therapy
- Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Michael Stuart Bronze, MD more...
Therapeutic Regimens
The arthropod Sarcoptes scabiei var hominis causes an intensely pruritic and highly contagious skin infestation. Scabies in adults frequently is sexually acquired, although scabies in children usually is not. The first time a person is infested with S scabiei, sensitization can take several weeks to develop; however, pruritus may occur within 24h after a subsequent reinfestation.[1]
Treatment recommendations
- Permethrin 5% topical cream applied from the neck down[1, 2] ; wash off after 8-14h; one application is usually sufficient, but a second application is recommended after 1wk or
- Ivermectin 200 mcg/kg PO once, repeated at 2wk if necessary; not recommended for pregnant or lactating patients, and safety in children who weigh < 15 kg has not been determined (off-label use) or
- Lindane 1% lotion or cream: Apply 30-60 mL from the neck down; wash off after 8-12h; no residual activity; increasing drug resistance; contraindicated in infants, children, women who are pregnant or nursing, elderly, persons with seizure disorders, persons who weigh < 110lb, and persons with itching/sores where lotion will be applied or
- Crotamiton 10% lotion or cream: Apply from the neck down on 2 consecutive nights; thoroughly massage into the skin of the whole body from the chin down, paying particular attention to all folds and creases; a second application is advisable 24h later; wash off 24h after second application; considered less effective than permethrin
Special considerations
- Patients should be informed that rash and pruritus of scabies may persist for up to 2wk after treatment[1, 2, 3]
- Particular attention must be given to the fingernails of these patients, and recommendations include advising patients to trim fingernails
- Treatment of fellow household members and close contacts, as well as washing clothing, bedding, and towels in warm or hot water, is recommended
- Items that cannot be washed can alternatively be isolated from use for 3d
- Infested individuals may be asymptomatic for up to 6wk but are able to transmit infestation; symptomatic individuals may harbor < 15 mites, making the location of burrows difficult
- Norwegian scabies is a severe infestation with crusted lesions, typically in elderly and immunocompromised individuals; it is highly contagious, with individuals harboring millions of mites
- Symptomatic individuals in an institutional setting indicate an infestation lasting several months; surveillance among institutionalized persons and staff, as well as control (ie, handwashing, avoidance of skin-to-skin contact with cases), should be put in place
Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. Dec 17 2010;59:1-110. [Medline].
Leone PA. Scabies and pediculosis pubis: an update of treatment regimens and general review. Clin Infect Dis. Apr 1 2007;44(Suppl 3):S153-9. [Full Text].
CDC. Parasites-Scabies. Accessed May 26 2011. Available at http://www.cdc.gov/parasites/scabies/treatment.html#general.
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