Who should be treated?
Scabies can stay in your skin for ever if not treated. Treatment is needed for:
- Anybody who has scabies; and
- All household members, close contacts, and sleeping/sexual partners of the affected person - even if they have no symptoms. This is because it can take up to six weeks to develop symptoms after you become infected. Close contacts may be infected, but have no symptoms, and may pass on the mite.
How is scabies treated?
Scabies is curable. The usual scabies treatment is with permethrin cream. Permethrin is an insecticide that kills the mites. This is known to be the treatment that works the best. If permethrin cannot be used, an alternative is to use a lotion called malathion liquid. (For example, some people may be allergic to permethrin.)
You can buy both of these products from pharmacies. You can also get them on prescription from a doctor. They are easy to apply and normally work well if used properly.
Re-apply the same treatment seven days after the first application. This helps to make sure that all the mites are killed.
What tips are there for successful scabies treatment?
- Read the leaflet that comes with the product, for exact instructions as to where to apply. Usually treatment is applied to your whole body, including the scalp and face, whilst other treatments are to be applied just from the neck down. Remember to include awkward places such as the back, soles of the feet, between fingers and toes, under fingernails, and the genitals. Pay special attention to the areas where mite tunnels (burrows) most commonly occur. That is, in between the fingers, the front of the wrists and elbows, beneath the breasts, the armpits and around the nipples in women.
- An adult needs at least 30 g of cream or 100 ml of lotion to cover the whole body. So, for two applications you will need at least 60 g of cream or 200 ml of lotion per adult.
- Apply cream or lotion to cool dry skin (not after a hot bath).
- The cream or lotion should be left on for the full recommended time. Permethrin cream should be left on for 8-12 hours. Malathion lotion should be left on for 24 hours.
- Children should stay off school until the first application of treatment has been completed.
- If you wash your hands or any other part of your body during the treatment period, you should re-apply the cream or lotion to the washed areas.
- Breast-feeding mothers should wash off the lotion or cream from the nipples before breast-feeding, and re-apply treatment after the feed.
- Permethrin cream is not usually used for babies under the age of 2 months, and malathion is not usually used under the age of 6 months.
- Put mittens on babies to stop them licking the cream or lotion off their hands.
- Clothes, towels and bed linen should be machine-washed at 50°C or above after the first application of treatment. This kills the scabies mites. Keep any items of clothing that cannot be washed, in plastic bags for at least 72 hours to contain the mites until they die. Alternative options to kill any mites on clothes and linen are ironing the item with a hot iron, dry cleaning, or putting items in a dryer on the hot cycle for 10-30 minutes. It is not necessary to fumigate living areas or furniture, or to treat pets.
- Some people who develop a secondary skin infection may also need antibiotics. If you suspect this is the case, you should consult a doctor.
See a doctor if the itch persists longer than 2-3 weeks after treatment. Sometimes the first treatment does not work, and a different one is then needed. The most common reasons why treatment fails, and scabies returns, are:
- The cream or lotion is not applied correctly for the recommended time.
- A close contact is not treated at the same time and the infection is passed back.
It is normal to take up to 2-3 weeks (and sometimes up to six weeks) for the itch to go completely after the mites have been killed by treatment. This is because your skin reacts to the mites and takes a while to settle down, even once the mites have been killed.
Also, even after successful treatment, in a small number of cases there remain some itchy brownish-red lumps (nodules) up to 2 cm in diameter. If these remain, they most commonly occur on the genitals and armpits. These lumps are neither infectious, nor mean that the mite is still present. They occur in some cases as a prolonged skin reaction to the scabies mite. If they occur, they usually go within three months but occasionally last up to one year.
What is the treatment for itching?
Itching can be a distressing symptom. It can be eased either with topical treatments that you apply to the skin (such as creams or lotions), or with medication taken by mouth. Your GP or pharmacist can usually give advice regarding suitable products. Even cold moisturisers (emollients), especially if they contain menthol, can provide temporary relief. Avoid applying strong steroid creams, especially if the diagnosis of scabies is uncertain.
- Crotamiton cream or lotion has soothing qualities and may help to relieve itch. Apply crotamiton 2-3 times a day (but only once a day for children less than 3 years old).
- Hydrocortisone cream. This is a mild steroid cream that may ease any inflammation and help to ease itch. It can be bought from the chemist, or obtained by prescription. It can be applied once or twice per day, for up to a week.
- An antihistamine medicine that makes you drowsy, such as chlorphenamine. This does not ease the itch directly, but can help you to sleep if itching is a problem at night (particularly for children). It is not licensed for this use but can be safely used under the direction of a doctor.
Did you find this information useful?
- Scabies; DermNet NZ
- Scabies, DermIS (Dermatology Information System)
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- Gunning K, Pippitt K, Kiraly B, et al; Pediculosis and scabies: treatment update. Am Fam Physician. 2012 Sep 15 86(6):535-41.
- FitzGerald D, Grainger RJ, Reid A; Interventions for preventing the spread of infestation in close contacts of people with scabies. Cochrane Database Syst Rev. 2014 Feb 24 2:CD009943. doi: 10.1002/14651858.CD009943.pub2.
- Engelman D, Kiang K, Chosidow O, et al; Toward the global control of human scabies: introducing the International Alliance for the Control of Scabies. PLoS Negl Trop Dis. 2013 Aug 8 7(8):e2167. doi: 10.1371/journal.pntd.0002167. eCollection 2013.
- Scabies; NICE CKS, May 2016 (UK access only)
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