When to Initiate Referral:

  • Treatment failure
  • Persistent scabies infections, especially in immunosuppressed patients

Treatment Basics

  • Scabies is an infestation of the skin by the mite Sarcoptes scabei
  • Usually transmitted by close person-to-person contact or by parents to children (especially mother to infant)
  • Severely itchy, especially at night
  • Usually distributed on the sides and webs of fingers, flexor wrists, extensor elbows, folds, peri-umbilicus and genitalia
    • Infants often have palm/soles involved
  • Skin lesions in children are typically more inflammatory, and are often vesicular or bullous

First Steps

  • Scabies is generally a clinical diag Skin scrapings or microscopic evaluation in the clinic can be used for confirmation.


  • Permethrin 5% cream: apply to all areas of the body from the neck down to the toes and wash off after 8-14 hours. Repeat after 1 week.
    • Permethrin appears to be safe and effective even when applied to infants less than 1 month of age. In infants, permethrin should also be applied to scalp and face, avoiding the eyes and mouth.
  • Itching and lesions often persist for several weeks after successful treatment. Oral antihistamines and/or low to medium potency topical steroids are appropriate for relief.

Control of Transmission

  • Recently used (within several days before treatment) clothing, linens, stuffed animals, e may be bagged for several days, machine washed, and then ironed, dried in a hot dryer, or dry cleaned.
  • All household members and close contacts should be treated simultaneously, even if they do not have skin lesions/rash.
  • Close contacts without skin lesions/rash generally do not need a second, repeat treatment.