Executive summary
- Diagnosis: intense itch (worse at night) + burrows/papules; household clustering is common.
- Treatment success hinges on technique: full-body application, correct contact coverage, and a repeat dose.
- Itch can persist for weeks after eradication — this does not automatically mean treatment failure.
Permethrin technique (the “how” that makes or breaks cure)
- Permethrin 5% cream: apply to cool, dry skin from neck down (include between fingers/toes, under nails, groin, buttocks).
- Leave on: typically 8–12 hours then wash off.
- Repeat: a second application 7 days later (very common reason for failure if omitted).
- Reapply to hands if washed during the treatment window.
Contacts and environment
- Treat close contacts (household/sexual/very close skin contact) at the same time, even if asymptomatic.
- Wash bedding/towels/clothes used recently at hot wash (or seal for several days if not washable) per local public health advice.
- Post-scabetic itch: emollients + topical mild steroid + non-sedating antihistamine may help symptoms.
Crusted scabies (don’t miss)
- High mite load with widespread crusting, often in immunosuppressed/older people → urgent specialist/public health input.
- Often needs combined topical + systemic strategies and robust contact tracing.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.