Scabies Treatment: What You Need to Know

By MaryAnn DePietro, CRT. Medically reviewed by Tom Iarocci, MD. May 7th 2016

An eight-legged bug (Sarcoptes scabiei) too small to see causes the itchy skin condition known as scabies. The tiny bug, or mite, tunnels into the epidermis and lays eggs that mature in 21 days, causing an infestation.

Infected individuals usually develop symptoms including a pimple-like rash and intense itching, but if it is the first time a person has had scabies, he or she may not develop symptoms for up to 6 weeks. In the interim, those infected are likely to be contagious despite not having symptoms.

Scabies can spread easily among people who have close physical contact with an infected person. The longer the skin-to-skin contact, the more likely the spread. Crusted (Norwegian) scabies is a more severe, more contagious form of infestation that occurs in people who are debilitated and/or with weak immune systems.

Treatment is needed to get rid of scabies and prevent it from spreading to others. It will not go away on its own. It is critical to understand what scabies treatment involves in order to effectively kill the mite, prevent secondary infections, and prevent reinfection.

Treatment Considerations

Treatment consists of killing the mites, symptom control, and decontamination.

In the United States a prescription is required for a medication, like permethrin cream, 5%, to treat scabies by killing the mites. There is no evidence at present to support the use of natural or homeopathic treatments for scabies.

In some instances, it takes several weeks for symptoms, such as itching, to start. It may be difficult to determine if a close physical contact of an infected individual has also contracted scabies, so treatment should be considered for all those who have had skin-to-skin contact with an infected individual. The longer the skin-to-skin contact, the greater the risk of transmission.

 The selection of particular medications may depend on several factors such as the age and overall health of the patient, tolerance for a particular treatment, and the severity of the infestation. Vigorous scratching may lead to a bacterial infection requiring treatment with an antibiotic, so treatments to relieve itching can also be important. 

Scabicides are Medications Used to Kill Scabies Mites

Scabicides work by killing the mites, and some scabicides kill the eggs as well. Most often, a scabicide is prescribed as a topical cream or lotion, which is applied all over the body, from the neck down. The most commonly prescribed scabicide is permethrin, 5%. 

Although the rash may not be present all over the body, patients are usually instructed to apply the cream to all areas of the body except the face. If infants are being treated, directions may include application of the cream to the scalp and head.

Follow the directions contained in the box or printed on the label for effective treatment. For instance, the medication might need to be left on the skin for a certain number of hours before washing it off. A second application of medication may also be needed in some cases. Attention to the area under the fingernails may be necessary.

Occasionally, an oral medication for scabies is prescribed. Some people may not respond to the topical creams or they may have scabs crusted over the skin. In these instances, an oral medication to kill the mites may be recommended. 

If the scabicide medication is used correctly, it usually kills the mites relatively quickly. After effective treatment, no new rashes will develop. Although the mites are killed, itching can still persist for a few weeks.

Next Steps: Home Care Essential to Treatment

Home care involves cleaning and removing the mites from areas of the home that the infected person may have come into contact with. This helps prevent reinfection and spreading the infection to others. Clothes, bedding and towels will need to be washed in hot water to kill mites. The person infected should also avoid skin-to-skin contact with others until after treatment.

It is important to understand anyone of any social class, race, or age can become infected with scabies. Fortunately, effective treatment is available. With the correct use of medication and proper home care, scabies can be effectively treated, and the spread of the condition prevented.

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