Scope of this summary
Patients with suspected or confirmed classic scabies and their close contacts. Crusted scabies, institutional outbreaks, pregnancy, very young infants and patients with substantial immunocompromise need tailored specialist or public-health input.
The Bottom Line
- Recognize intense itch, often worse at night, with burrows or papules in a compatible distribution and an exposure history; confirm with microscopy, dermoscopy or skin scraping when the diagnosis is uncertain or an outbreak decision depends on it.
- Use an approved or CDC-recommended scabicide correctly over the full required skin surface. Permethrin 5% is FDA approved from two months of age; oral ivermectin is an effective alternative for appropriate patients but has important population limits.
- Treat household members and close skin-to-skin or sexual contacts at the same time, even when symptoms have not yet developed, to interrupt reinfestation.
- Wash recently used clothing and bedding hot and dry hot, dry-clean them, or seal items that cannot be washed for the CDC-defined interval; mites generally do not survive more than two to three days away from human skin.
- Expect itch to persist for several weeks after successful treatment, but reassess for new burrows, new lesions, incorrect application, untreated contacts or an alternative diagnosis when symptoms continue.
Practical clinical workflow
1
Map the rash and itch, examine finger webs, wrists, waist, genital and buttock regions and age-specific sites, and ask about household, intimate, facility and caregiving exposures.
2
Select treatment from age, pregnancy or lactation, body weight, extent, immune status, adherence feasibility and local resistance or outbreak advice; give written whole-body application instructions.
3
Arrange simultaneous treatment for contacts and explain laundering or bagging of recently used textiles, nail care and avoidance of direct skin contact until the treatment interval is completed.
4
For classic scabies, repeat treatment when the selected CDC regimen calls for it; do not interpret early persistent itch alone as treatment failure.
5
Review ongoing new lesions or itch beyond two to four weeks, confirm adherence and contact treatment, repeat diagnostic testing if needed, and involve infection prevention or public health for congregate outbreaks.
Safety boundaries and escalation
- Crusted scabies is highly contagious and may show widespread scale with little itch; isolate appropriately and obtain urgent expert treatment using combined topical and oral therapy under the CDC regimen.
- The safety of oral ivermectin is not established in pregnancy or in children weighing less than 15 kg; use population-specific expert advice rather than extrapolating an adult regimen.
- Secondary bacterial infection, fever, spreading erythema or systemic illness requires prompt assessment and treatment separate from the mite eradication plan.
- Do not use insecticide sprays or fumigants on the home or body, and do not substitute over-the-counter products because no nonprescription scabies treatment is FDA approved.
Localization
CDC clinical-care and treatment pages define the US approach. State and local public-health departments, schools, long-term-care facilities and occupational-health services may impose additional outbreak rules.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- Centers for Disease Control and PreventionClinical Care of Scabiesupdated 2023-12-18 路 accessed 2026-08-20view source
- Centers for Disease Control and PreventionTreatment of Scabiesupdated 2024-01-12 路 accessed 2026-08-20view source
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