Dr Kola Tytler MBBS CertHE MBA MSt MRCGPClinical Lead • iatroX
First-line treatment
- For uncomplicated classical scabies in adults and children aged 2 months or over, use either permethrin 5% cream or oral ivermectin 200 micrograms/kg; give a second treatment dose 7–14 days later. NICE CKS
- Consider oral ivermectin rather than permethrin in people with pre-existing eczema or other skin disease that could predispose to hypersensitivity. NICE CKS
- Seek specialist advice for infants under 2 months, as permethrin safety and efficacy are not established in this age group. NICE CKS
Permethrin 5% cream regimen
- Apply a thin layer to clean, dry, cool skin, leave it on for 8–12 hours, then wash the whole body thoroughly; reapply to the hands if they are washed during the treatment period. SmPC Permethrin
- Repeat the full application 7–14 days after the first treatment. SmPC Permethrin
- In adults, adolescents and children over 2 years, cover the whole body including the neck, palms and soles, treating finger and toe webs, beneath nails, wrists, elbows, axillae, external genitalia and buttocks; the head and face can be omitted unless involved. SmPC Permethrin
- In children under 2 years, also cover the neck, face, ears and scalp, avoiding the eyes and skin around the mouth; prevent licking from hands and use gloves if necessary. SmPC Permethrin
- Maximum quantities per application are 30 g for adults and adolescents over 12 years, 15 g for children aged 6–12 years, and 7.5 g for children aged 2 months–5 years. SmPC Permethrin
- Children aged 2 months to 23 months should receive permethrin only under close medical supervision. SmPC Permethrin
Oral ivermectin regimen
- Give ivermectin 200 micrograms/kg orally, followed by a second dose 7 days later. NICE CKS
Contacts and prevention of reinfestation
- Treat the affected person at the same time as all household members, sexual partners from the previous month and other close personal contacts, even when asymptomatic. NICE CKS
- Consider GUM referral where partner notification is required. NICE CKS
- Decontaminate bedding, clothing and towels used by the patient and potentially infested contacts by washing at at least 60°C and hot tumble-drying, dry-cleaning, or sealing items in a plastic bag for at least 72 hours. NICE CKS
After treatment
- Itch can persist for up to 4 weeks despite successful eradication; manage post-scabetic itch with crotamiton 10% cream or, once eradication is definite, hydrocortisone 1% cream, with a sedating antihistamine at night if needed for sleep and scratching. NICE CKS
- Review if itch persists beyond 2–4 weeks after the last treatment application, or if new lesions develop. NICE CKS
- Suspected crusted scabies requires urgent specialist dermatology advice, possible admission and isolation with barrier nursing, and may require combined topical insecticide plus oral ivermectin. NICE CKS