It’s usually spread when someone has prolonged, skin-to-skin contact with someone else who is infested with scabies. The mites don’t survive long when not on human skin, but in some cases, they can be contracted from the clothing, bedding, or upholstered furniture used by a person with scabies. If someone has scabies, it’s important that their close contacts, including sexual partners and any members of their household, get treated as well — and at the same time — to avoid reinfestation or re-exposure. (1) A typical case of scabies can be treated with prescription topical creams that kill the mites and resolve symptoms. More severe cases involving widespread presence of mites — such as crusted scabies, also known as Norwegian scabies — require an oral medicine. Your healthcare provider will examine you, looking for signs of a scabies rash and burrows. To confirm the diagnosis of scabies, your healthcare provider may need to identify the mite, mite eggs, or the mite’s fecal matter. Your doctor might take a skin scraping — painlessly removing a bit of skin — to look at under a microscope. (4) Or your doctor might use the end of a needle to remove a mite from its burrow. (5) The Centers for Disease Control and Prevention (CDC) notes, though, that you can still have scabies even if mites can’t be found. Otherwise healthy people might have fewer than 10 mites, which may go undetected. For common scabies, patients may be given one or more of these drugs, also known as scabicides: (7)
Permethrin topical (Elimite) has been approved by the Food and Drug Administration (FDA) for the treatment of scabies. It’s the most commonly used scabies medication, safe for children older than 2 months, as well as pregnant women. (4) This topical cream kills the scabies mite and eggs; to eliminate all mites, two (or more) applications about a week apart may be needed.Crotamiton topical (Eurax) lotion and cream are FDA-approved for scabies treatment in adults, but not in children. The CDC notes that treatment failure has frequently been reported. (7)Sulfur topical (Sulfoam) ointment is a safe option for topical use in children, including those younger than 2 months.Lindane lotion, notes the CDC, should only be given to patients for whom treatment with drugs that pose less risk has failed. Misuse of this product can be toxic.
Topical medicines are applied from the neck down, including on feet and toes. (1) Infants and young children may need to treat their scalp and face, too. The scabicide should be applied to clean, dry skin and left on for the amount of time indicated in the prescribing information (8 to 14 hours), and then washed off. (4) This process generally needs to be repeated again in a week. Follow the directions on the label; overtreating the skin can worsen symptoms. (4) For widespread scabies all over the body and crusted scabies, the oral antiparasitic medicine ivermectin (Stromectol) will likely be prescribed. These pills are generally taken once every two weeks, and while some patients only need one dose, two to three doses may be required to cure scabies. Ivermectin can be given to children. (4) The CDC cautions that while ivermectin is FDA-approved for the treatment of worm infestations, it’s not technically approved for the treatment of scabies and should be used when approved topical treatments have failed, or in patients who can’t tolerate the topical treatments. (7) Along with oral medication, topical benzyl benzoate 25 percent (with or without tea tree oil) may be used as an alternative topical agent to permethrin, though the CDC notes it may cause immediate skin irritation. Keratolytic cream might also be used to help reduce the crusting of the skin and help the skin absorb topical permethrin or benzyl benzoate. (7) Your doctor might also prescribe an antihistamine or pramoxine (Proctofoam) lotion to help control your itching. To lessen redness and swelling, a steroid cream might be recommended. If itching has led to infection, you’ll likely be given an antibiotic. (4) Itching may continue for a few weeks after treatment even if all the mites and eggs have been eliminated, because the skin is still having an allergic reaction. If itching persists more than two to four weeks after treatment, or if you see any new burrows or any signs of the pimple-like scabies rash, you might need to be retreated. (6) People with crusted scabies often need repeat treatments. (4) Any bedding, clothing, and towels that were used by a person with scabies or anyone they came in close contact with any time before the three days of their treatment needs to be decontaminated. This can be done by washing these items in hot water and drying on high heat, by dry-cleaning, or by sealing these articles in a plastic bag for at least 72 hours. (1) This starves the mites, which die after a few days with no food. (9) You should also vacuum your entire home the day you start treatment. (4) If you’re sexually active, it’s best not to have sex until you or your partner (whoever is infected) has finished treatment. While condoms help prevent the spread of sexually transmitted infections, they won’t keep you from getting scabies from your sexual partner
