Clinical practice guidelines for the Treatment of Scabies

International Journal of Dermatology: June, 2024

Recent guidelines emphasize a multimodal approach to scabies management, combining topical and systemic therapies.

First-line therapy: Topical Permethrin is recommended as first-line therapy, with Benzyl benzoate, Sulfur ointment and Crotamiton as alternatives.

Ivermectin remains a primary choice for oral treatment, particularly in outbreaks or severe cases.

For crusted scabies, it is recommended to administer three to seven doses of ivermectin, depending on the severity of the disease. In those patients, oral ivermectin treatment should be given along with medication for topical scabies (e.g., permethrin or benzyl benzoate).

For resistant cases, combination therapies are advised. Emphasis on treating household contacts and proper environmental cleaning is crucial.

Take Home Messages

Treat all close contacts simultaneously. Family members and those in close contact with the scabies patient should also be treated, even if there is no clinical evidence of scabies.
Post-treatment itching may persist for 2–4 weeks, requiring symptomatic relief.
Environmental decontamination reduces reinfestation risks.
Washing all items that may carry mites at high temperatures (>50 °C) or storing items, such as clothing, linens, bedding, children's fabrics, and stuffed animals in sealed plastic bags, may reduce the spread of scabies.

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Key Prescribing Notes

Ivermectin: Single dose (200 µg/kg), repeated after 1–2 weeks if necessary.
Permethrin Cream 5%: Applied head-to-toe, left overnight, repeated in 7 days. Pregnancy category B.
Benzyl Benzoate 25%: Applied for 3 consecutive days. In Pregnancy not recommended.
Crotamiton 10% cream or lotion: Applied for two consecutive nights. Pregnancy category C. Not recommended in Children.
Sulfur-based ointments 2–12.5%: Apply for 3 consecutive days and repeat after 1 week. Pregnancy category C.