- First-line treatment for scabies is 5% permethrin cream left on overnight, two applications seven days apart. Adults apply from neck downwards; babies/infants apply to all the skin.
- Second line is 0.5% malathion lotion left on overnight (applied as above).
- Ivermectin 0.2 mg/kg, two doses seven days apart (named-patient basis, UK) can be given to immunocompromised patients and those with crusted scabies (avoid in patients 15 kg and in pregnancy). A new single dose oral agent (phase III trials) moxidectin is expected to be approved for use soon.
- If you suspect genuine resistance (i.e. the treatment has been carried out according to your instructions), then switch to a different class of insecticide.
- Pruritus can be alleviated with menthol in aqueous cream, crotamiton, or doxepin. In severe cases, a topical steroid can be applied twice daily to settle persistent nodular skin reactions.
- If permethrin and malathion are not available, then 10% sulfur in yellow soft paraffin is effective and safe; 25% benzyl benzoate emulsion may also be used.
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