What is the treatment for a scabies infestation?

Curing scabies is rather easy with the administration of prescription scabicide drugs. There are no approved over-the-counter preparations that have been proved to be effective in eliminating scabies. The following steps should be included in the treatment of scabies:

1. Apply a mite-killer like permethrin (Elimite). These creams are applied from the neck down, left on overnight, then washed off. This application is usually repeated in seven days. Permethrin is approved for use in people 2 months of age and older.

2. An alternative treatment is 1 ounce of a 1% lotion or 30 grams of cream of lindane, applied from the neck down and washed off after approximately eight hours. Since lindane can cause seizures when it is absorbed through the skin, it should not be used if skin is significantly irritated or wet, such as with extensive skin disease, rash, or after a bath. As an additional precaution, lindane should not be used in pregnant or nursing women, the elderly, people with skin sores at the site of the application, children younger than 2 years of age, or people who weigh less than 110 pounds. Lindane is not a first-line treatment and is only recommended if patients cannot tolerate other therapies or if other therapies have not been effective.

3. Ivermectin, an oral medication, is an antiparasitic medication that has also been shown to be an effective scabicide, although it is not FDA-approved for this use. The CDC recommends taking this drug at a dosage of 200 micrograms per kilogram body weight as a single dose, followed by a repeat dose two weeks later. Although taking a drug by mouth is more convenient than application of the cream, ivermectin has a greater risk of toxic side effects than permethrin and has not been shown to be superior to permethrin in eradicating scabies. It is typically used only when topical medications have failed or when the patient cannot tolerate them.

4. Crotamiton lotion 10% and cream 10% (Eurax, Crotan) is a another drug that has been approved for the treatment of scabies in adults, but it is not approved for use in children. However, treatment failures have been documented with the use of crotamiton.

5. Antihistamines, such as diphenhydramine (Benadryl), can be useful in helping provide relief from itching.

6. Wash linens and bedclothes in hot water. Because mites don't live long away from the body, it is not necessary to dry-clean the whole wardrobe, spray furniture and rugs, and so forth.

7. Treat sexual contacts or relevant family members (who either have either symptoms or have the kind of relationship that makes transmission likely).

Just as the itch of scabies takes a while to reach a crescendo, it takes a few days to subside after treatment. After a week or two, relief is dramatic. If that doesn't happen, the diagnosis of scabies must be questioned.