Scabies

Household members and close contacts are often treated at the same time, even if they have no itch yet, so the mites are not passed back and forth.

Often considered when a person is diagnosed with scabies, because people can carry mites for weeks before itching starts.

Plans for babies, pregnant people and people with other health conditions may differ, so a clinician usually guides who gets what.

Reinfestation (getting scabies again) is common when contacts are missed.

Clinicians usually judge success over several weeks, since itch lingers.

• Who in my household or circle should be treated at the same time as me?
• How long should we limit close skin contact?

Items worn or used closely in the days before treatment are commonly washed in hot water and dried on high heat. Items that cannot be washed may be sealed in a bag for several days.

Often considered around the time treatment starts, since mites can briefly survive off the skin.

Delicate items may not tolerate heat, so dry cleaning or sealing in a bag may be discussed instead.

Deep cleaning the whole house is generally not needed. Mites live only a few days off the skin.

A one-time step around treatment time.

• Which items really need washing in my situation?
• How should we handle things we cannot wash?

Plain moisturizers, cool compresses and cool baths can calm itchy skin. Oral antihistamines are sometimes used for itch or sleep.

Often considered alongside treatment, since itching can continue for weeks after the mites are gone.

Sedating antihistamines may not suit young children, older adults or people on certain medicines. These products do not kill mites.

Fragranced products can irritate. Drowsiness with some antihistamines.

Helps comfort in days, but does not clear scabies.

• Which itch relief is safe for me?
• Can I use these with my scabies treatment?

Permethrin is a topical medicine (a scabicide) applied to the skin to kill scabies mites. It is the most commonly used first-line treatment.

Often considered for most children and adults with confirmed or strongly suspected scabies, as a first choice in many guidelines.

May be less suitable for very young infants, or for people who have had a reaction to it or to related ingredients. A clinician decides about pregnancy and breastfeeding.

Temporary stinging, burning, redness or more itching can happen. Itch often continues for weeks even when it works.

Clinicians often judge success after about 4 weeks, because itch fades slowly.

• Is permethrin right for me or my child?
• Will we need a second round?
• How can I tell if it worked?

Other creams, lotions or ointments, such as sulfur ointment, benzyl benzoate, crotamiton or spinosad, are sometimes used when permethrin is not suitable or has not worked.

May be discussed when permethrin is not available, not tolerated, or has not cleared the infestation.

Availability and suitability vary by country, age and pregnancy status. Some can be messy or irritating.

Skin irritation, dryness or a strong smell. Some have lower success rates.

Often judged after several weeks.

• Why are you suggesting this one instead of permethrin?
• Is it safe for my age or situation?

After mites are cleared, some people still have itchy, inflamed skin. Clinicians sometimes discuss a short course of a prescription steroid cream to calm that leftover reaction.

May be discussed when the itch and bumps remain weeks after effective treatment.

Not suited to skin that may still have mites, to infected skin, or for long use on thin skin like the face and folds.

Skin thinning or irritation with overuse, and lighter spots on darker skin.

Often judged over a few weeks.

• Is my itch from mites or from the leftover reaction?
• How long is it safe to use a steroid cream?

A clinician may look at the skin, use a handheld magnifier (dermoscopy), or gently scrape a burrow to view under a microscope. Scabies is often diagnosed from the story and look of the rash.

Often considered when the rash is unclear, when other conditions such as eczema could be the cause, or before treating a large group.

A negative scraping does not rule scabies out, since there may be very few mites.

A scraping may feel scratchy. Result can still be uncertain.

The visit itself is quick. Treatment decisions are often made the same day.

• How sure are you that this is scabies?
• What else could this be if treatment does not help?

Ivermectin is a tablet medicine that kills mites. Clinicians use it for scabies, and the CDC notes it is not FDA-approved for this use in the United States, though it works about as well as permethrin in studies.

Often considered when creams are hard to use, for outbreaks in group settings, when topical treatment has not worked, or for crusted scabies (usually together with a cream).

Safety is less established for young children (generally under about 15 kg) and during pregnancy, so it may be less suitable there. It can interact with some medicines.

Mild stomach upset, dizziness or headache can occur. Itch may flare briefly as mites die.

Repeat treatment is sometimes planned by the clinician. Success is usually judged weeks later.

• Would a tablet make more sense than a cream for me?
• Does it interact with my other medicines?
• Do I need a repeat course?

Crusted scabies carries very large numbers of mites. Clinicians often use a combination of an oral medicine and a cream, with careful infection control, and sometimes care from a specialist.

Considered in older adults, people with weak immune systems, or those with thick, scaly, crusted skin.

This is not something to manage at home on your own. Isolation and cleaning needs are higher.

Higher risk of skin infection and of spreading to caregivers and others.

Often takes longer and needs repeat checks by a clinician.

• Could this be crusted scabies?
• What precautions do caregivers and family need?