Therapeutic target
- Elimination of scabies mites (Sarcoptes scabiei variatio hominis; parasite).
- Partner management, i.e., infected partners, if any, must be located and treated (contacts must be traced for 2 months).
Therapy recommendations
- Scabicidal/anti-mite agents (first-line agent: permethrin; note advice on age; pregnancy/breastfeeding; scabies norvegica sive crustosa):
- Infants, including neonates: inpatient therapy (5% permethrin; crotamiton ointment).
- After topical whole-body treatment (all skin regions including scalp, groin, umbilicus, external genitalia, interdigital spaces between fingers and toes, and skin under nail ends) at night (8-12 h), a full bath with detergent and antiseptic must be taken in the morning to wash off residues.
- Ivermectin (oral) or benzyl benzoate (second-line agent): especially in case of non-response to permethrin.
- Postscabial granulomas (no longer contagious/infectious; appearance of papules and nodules still for weeks and months after successful therapy with scabicides): anti-inflammatory therapy (e.g., topical corticosteroids)
- See also under “Further therapy.”
For safety reasons, repeat local therapy after 7 days at:
- Immunocompromised patients
- Scabies crustosa
- Extensive scabies (many duct-like papules or nodules).
- Scabies outbreaks in homes and if multiple people are affected (breaking chains of infection.
- Doubts about treatment compliance
Suspicion of infestation of a community facility
- People who have been in close contact with the infected person should be treated, even if they do not show symptoms: single administration of 200 µg ivermectin per kilogram of body weight and a second dose after two weeks.