Scabies Treatment

Keratolytics (Topical)

• The removal of crust and scales with keratolytics is necessary for scabicide penetration of crusted scabies

Ivermectin (Oral)

• Effective treatment option for scabies patients unresponsive to 1st-line/2nd-line treatment
• Combination therapy with topical scabicides is considered to be the best option for crusted scabies
• May have a role in the treatment of refractory infestations and immunocompromised patients, or when administration of head-to-toe topical therapy would be difficult
  • May also be used in scabies epidemics in institutions

• Interrupts gamma-aminobutyric acid (GABA)-induced neurotransmission of many parasites
• Efficacy is comparable with topical Permethrin and more superior than Lindane

Scabicides (Topical)

Benzyl Benzoate

• Effective in the management of Permethrin-resistant crusted scabies
• Different treatment regimens have been used but no comparative data have been published
• May be used alone or in combination with Sulfiram
• Maybe used with Ivermectin for patients with relapses after single treatment of Ivermectin

Crotamiton

• May be useful for the treatment of nodule scabies in children but may require up to 5 days of treatment
• May be used for symptomatic relief from pruritus but there is conflicting evidence of its efficacy
• Appears to be less effective as a scabicide than Permethrin and Lindane

Ivermectin

• 1% lotion was reported to be as effective as 5% Permethrin cream

Lindane (Gamma Benzene Hexachloride)

• Used only as an alternative therapy in patients intolerant of other therapies or when other therapies fail due to risk of neurotoxicity
• When used properly, it is an effective scabicide
  • 1% formulation is usually effective after a single 6-hour treatment

• Lindane-resistant scabies has been noted in North, Central and South America and in Asia
• Not recommended in patients with crusted scabies due to risk of toxicity

Malathion

• Overnight application of 5% aqueous preparation is an effective treatment option
• Alternative for patients where treatment with Permethrin is not appropriate

Permethrin

• Recommended 1st-line treatment for children and adults including pregnant and lactating women
• Has been shown to be as effective as Lindane and more effective than Crotamiton
• Impairs function of voltage-gated sodium channels in insects which leads to disruption of neurotransmission
• Has low toxicity

Sulfur

• The oldest known treatment for scabies
• Safe and effective, but requires application on 3 consecutive days
• Treatment option for infants and pregnant women with scabies
• Reproduction studies have not been conducted

Sulfiram

• May also be used to treat human scabies
  • Soap-containing monosulfiram have been used in the past as a prophylaxis for scabies

Other Therapies

• Nodular scabies may be treated with corticosteroids after completed scabicide therapy
• Oral antihistamines may be given to help alleviate pruritus
• Medium- or high-potency topical steroids may also be given to help control pruritus after scabicide therapy
• Secondary infections should be treated with appropriate antibiotics