Scabies Organism-Specific Therapy 

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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 24 hours after a subsequent reinfestation. ^[1]

See When Bugs Feast: What’s Causing that Itch?, a Critical Images slideshow, to help identify various skin reactions, recognize potential comorbidities, and select treatment options.

See the list below:

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

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 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

*NOTE: Lindane is potentially neurotoxic and is considered a second-line drug for scabies in the event of failure of other medicines.   The World Health Organization classifies lindane as “Moderately Hazardous”. Since 2009, it is restricted and regulated under the Rotterdam Convention.  It is not available in certain states such as California, although there is a specific exemption to the general ban, allowing it to  be used as a second-line pharmaceutical treatment for lice and scabies in some places.

Patients should be informed that rash and pruritus of scabies may persist for up to 2 weeks 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 3 days.

Infested individuals may be asymptomatic for up to 6 weeks but are able to transmit infestation; symptomatic individuals may harbor less than 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.

The US Centers for Disease Control and Prevention offer the following suggested guidelines for the treatment of scabies ^[3] :

Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64 (RR-03):1-137. [Medline].

Leone PA. Scabies and pediculosis pubis: an update of treatment regimens and general review. Clin Infect Dis. 2007 Apr 1. 44 Suppl 3:S153-9. [Medline]. [Full Text].

Centers for Disease Control and Prevention. Parasites-Scabies. Available at http://www.cdc.gov/parasites/scabies/treatment.html#general. September 3, 2015; Accessed: April 30, 2016.

Darvin Scott Smith, MD, MSc, DTM&H Adjunct Associate Clinical Professor, Department of Microbiology and Immunology, Stanford University School of Medicine; Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Permanente Medical Group

Darvin Scott Smith, MD, MSc, DTM&H is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Scabies Organism-Specific Therapy 

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