What is the proper pharmacologic treatment of crusted scabies?

Updated: Oct 13, 2020
  • Author: Megan Barry, MD; Chief Editor: Dirk M Elston, MD  more...
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Patients with crusted scabies or their caregivers should be instructed to remove excess scale in order to allow penetration of the topical scabicidal agent and decrease the burden of infestation. This can be achieved with warm water soaks followed by application of a keratolytic agent, such as 5% salicylic acid in petrolatum or Lac-Hydrin cream. (Salicylic acid should be avoided if large body surface areas are involved because of the potential risk of salicylate poisoning.) The scales are then mechanically debrided with a tongue depressor or similar unsharp device.

Because of their heavy mite burden, patients with crusted scabies may require repeated applications of topical scabicides or treatment that simultaneously uses oral ivermectin and a topical agent, such as permethrin

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