How should scabies mites be treated? - briefly
Apply a topical scabicide—commonly 5 % permethrin cream left on the skin for 8–14 hours and repeated after 7 days—to eradicate the mites. For refractory or widespread infestations, a single dose of oral ivermectin (200 µg/kg) may be administered, with a repeat dose in one week if needed.
How should scabies mites be treated? - in detail
Effective management of scabies requires a combination of pharmacologic therapy, hygiene measures, and follow‑up assessment. The primary objective is to eradicate the Sarcoptes scabiei mite and prevent reinfestation.
First‑line agents are topical scabicidal preparations applied to the entire body from the neck down, and in infants, to the scalp and face as well. The most widely used products include:
- Permethrin 5 % cream: applied for 8–14 hours, then washed off; repeat after 7 days to eliminate newly hatched mites.
- Benzyl benzoate 10–25 % lotion: applied for 24 hours, then removed; a second application after 7 days is recommended.
- Sulfur ointment 5–10 %: safe for pregnant women and young children; applied nightly for 3–5 days, then repeated after a week.
Oral ivermectin serves as an alternative or adjunct, especially for crusted (Norwegian) scabies, immunocompromised patients, or when topical treatment fails. Standard dosing is 200 µg/kg body weight, taken on day 1 and repeated on day 2; a third dose may be given a week later for severe cases.
Adjunctive measures enhance treatment success:
- Wash all bedding, clothing, and towels in hot water (≥ 50 °C) and dry on high heat; items that cannot be laundered should be sealed in plastic for at least 72 hours.
- Treat household contacts simultaneously, even if asymptomatic, to break transmission chains.
- Apply soothing creams or antihistamines to relieve itching; avoid scratching to reduce secondary infection risk.
- Perform a skin examination 2–4 weeks after therapy to confirm resolution; persistent lesions may indicate treatment failure or secondary infection.
In cases of extensive crusted disease, combine oral ivermectin with daily topical scabicide, and consider decontamination of the environment more aggressively. Monitor for adverse reactions, particularly neurotoxicity with ivermectin in patients with severe hepatic impairment, and for skin irritation with topical agents.
Overall, a structured regimen of appropriate scabicidal medication, rigorous environmental decontamination, and simultaneous treatment of close contacts ensures complete eradication of the mite and minimizes recurrence.