Treatment of classic scabies in the community setting

Algorithm refers to the treatment of adults and children at least 2 months of age. Treatment of scabies must include these important adjunctive measures:

Close contacts – Ensure simultaneous treatment of patient and close contacts. Treatment options and protocols for patients and contacts are identical.
Environment – Clothing and bedding used within the preceding 3 days should be machine washed and dried with hot water and a hot dry cycle, dry cleaned, or removed from human contact for at least 72 hours.
Pruritus – Manage with oral antihistamines or topical corticosteroids, as needed. Refer to additional UpToDate content on the management of scabies for details.

* Alternative topical therapies include benzyl benzoate, precipitated sulfur, topical ivermectin, and spinosad. These therapies have not been proven more effective than permethrin and are primarily used when permethrin therapy is not feasible. Refer to additional UpToDate content for details on preferred alternatives for children and pregnant individuals. Use of lindane has fallen out of favor due to risk for systemic toxicity.
¶ Repeating treatment is generally considered to improve efficacy. However, superiority of 2 applications of permethrin versus 1 application of permethrin has not been proven.
Δ The best approach to retreatment has not been established. We typically switch to another first-line therapy (eg, from permethrin to oral ivermectin) or treat with permethrin or ivermectin simultaneously. Refer to additional UpToDate content on the management of treatment failure in scabies for details.

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Treatment of classic scabies in the community setting