What to apply to a scabies mite?

What to apply to a scabies mite? - briefly

Apply a topical scabicide, most commonly 5 % permethrin cream, to the entire body and leave it on for the recommended duration. Oral ivermectin is an effective alternative for patients who cannot tolerate or adequately respond to the cream.

What to apply to a scabies mite? - in detail

Scabicidal agents are the primary means of eliminating the mite responsible for scabies. The most widely recommended topical preparation is a 5 % permethrin cream applied to the entire body from the neck down (or to the whole body in infants) and left in place for 8–14 hours before washing off. A second application after 24 hours improves eradication rates. Permethrin is safe for children older than 2 months and for pregnant or lactating women; transient burning or itching may occur.

When topical therapy is unsuitable or when extensive disease is present, oral ivermectin provides an effective systemic alternative. A single dose of 200 µg/kg is administered, with a repeat dose 7–14 days later to target newly hatched mites. Ivermectin is contraindicated in children weighing less than 15 kg and in women who are pregnant or breastfeeding; common adverse effects include mild headache, dizziness, or gastrointestinal discomfort.

Additional topical options include:

  • Benzyl benzoate 25 % lotion – applied to the entire skin surface, left for 24 hours, then washed off; may cause intense irritation.
  • Crotamiton 10 % cream – applied twice, 24 hours apart; less irritating but slightly less effective than permethrin.
  • Sulfur 5–10 % ointment – applied nightly for 3 days, then twice weekly for 2 weeks; safe for infants and pregnant women, but odorous and messier.
  • Lindane 1 % lotion – single application; neurotoxic risk limits use to cases where other agents fail.

Environmental control complements pharmacologic treatment. All bedding, clothing, and towels used within the previous 72 hours should be laundered in hot water (≥ 50 °C) and dried on high heat. Items that cannot be washed may be sealed in plastic bags for at least 72 hours to deprive mites of a host. Vacuuming carpets and upholstered furniture reduces residual contamination.

Monitoring treatment response involves assessing symptom resolution 2–4 weeks after therapy. Persistent itching may indicate secondary infection or reinfestation; a repeat course of the chosen agent or an alternative medication is warranted. In immunocompromised patients, more aggressive regimens—such as combined oral ivermectin and topical permethrin—may be necessary to achieve clearance.