Lice and Scabies: Treatment Update

Karen Gunning, PharmD; Bernadette Kiraly, MD; Karly Pippitt, MD


Am Fam Physician. 2019;99(10):635-642. 

In This Article

Treatment of Scabies

Permethrin 5% cream (Elimite) is the first-line treatment for scabies.[29] Physicians should educate their patients about correct application of permethrin cream, reminding them that it should be applied to all areas of the body from the neck down, remain on the skin for eight to 14 hours or overnight, washed off, and reapplied in one week. Patients should be told that they may continue to itch for up to two weeks, even after appropriate and effective treatment. Persistent posttreatment symptoms should prompt consideration of misdiagnosis, treatment failure, or treatment-related skin irritation.[25,32] Sex partners from the past two months should be treated.[10,31]

Treatment with oral ivermectin (200 mcg per kg, two doses 14 days apart) is an option for scabies according to the Centers for Disease Control and Prevention, although cost and availability often limit it to second-line therapy if treatment with topical permethrin is unsuccessful.[10,31]

Environmental control measures for scabies include washing items such as sheets and clothing at a temperature of at least 122°F (50°C) and drying in a hot dryer. For items that cannot be machine washed, isolation in a sealed plastic bag for at least one week is sufficient.[31]