How should scabies mites be treated in adults? - briefly
First‑line treatment is a single application of 5 % permethrin cream to the whole body, left on for 8–14 hours and then washed off, with a repeat dose after 24 hours to enhance efficacy. Oral ivermectin 200 µg/kg, given once and repeated after one week, serves as an alternative for those unable to use topical therapy or with widespread infestation.
How should scabies mites be treated in adults? - in detail
Effective management of scabies in adult patients requires a combination of pharmacologic therapy, hygiene measures, and follow‑up assessment. First‑line medication is a topical 5 % permethrin cream applied to the entire body from the neck down, left on for 8–14 hours, then washed off. A second application after 24 hours eliminates newly hatched mites. Alternatives include 1 % lindane lotion (single application) for individuals without seizures, and 10 % sulfur ointment applied nightly for 3 days, suitable for pregnant or lactating patients.
Oral ivermectin provides systemic treatment, especially for crusted scabies or when topical agents are impractical. The standard regimen is 200 µg/kg body weight taken on day 1 and repeated on day 2; a third dose on day 7 may be added for severe cases. Ivermectin is contraindicated in children under 15 kg, pregnant women, and patients with known hypersensitivity.
Adjunctive measures reduce reinfestation risk:
- Wash all clothing, bedding, and towels in hot water (≥ 50 °C) and dry on high heat for at least 30 minutes.
- Seal items that cannot be washed in a sealed plastic bag for 72 hours, as mites cannot survive without a host beyond this period.
- Vacuum carpets and upholstered furniture, then discard vacuum bags.
- Treat close contacts simultaneously, even if asymptomatic, to prevent recurrence.
Monitoring includes re‑examination 2–4 weeks after therapy completion. Persistent burrows or new lesions warrant repeat treatment with the same or an alternative agent. Patients should be instructed to avoid scratching to prevent secondary bacterial infection; if infection occurs, appropriate antibiotics are required.
In summary, adult scabies is controlled primarily with 5 % permethrin cream, supplemented by oral ivermectin for resistant or extensive disease, combined with rigorous decontamination of personal items and simultaneous treatment of contacts, followed by clinical review to confirm eradication.