Scabies: Drug Therapy

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):
  • 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.