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Chapter 150: Scabies

Sreepriya Gayam; Craig N. Burkhart

SCABIES

Therapeutic Approach

Scabies is an infestation caused by the Sarcoptes scabiei var. hominis mite that lives its entire life cycle within the epidermis and is spread through personal contact. Clinical presentation is characterized by the following: pruritus with excoriations and eczematous dermatitis that favors interdigital webs, volar aspects of the wrists, lateral palms, elbows, intertriginous areas (axilla), trunk, and anogenital areas. Crusted “Norwegian” scabies is characterized by hyperkeratotic plaques or thickening of the nails, and is most effectively treated with a combination of a topical and systemic therapy. To reduce potential for reinfestation, all family members in the household and close contacts must simultaneously be treated. In addition, regardless of subtype, it is advised to thoroughly clean the household (clothes, bedding, towels, etc.) after completing treatment.1,2 See Table 150-1.

Table 150-1Scabies Treatment Table
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Table 150-1 Scabies Treatment Table
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MEDICATION NAME INDICATIONb MECHANISM OF ACTION DOSING ADVERSE EFFECTS SUGGESTED MONITORING LEVEL OF EVIDENCE (REFERENCE)
Topical Therapy      
Permethrina,c

S, CS

≥2 mo of age

 Antiparasitic, synthetic pyrethroid agent, sodium channel blocker

5% cream;

Apply to entire skin surface (neck to soles of feet) for 8-14 h, then wash off, repeat in 7 d.

If pregnant, breastfeeding or <2 y of age, repeat application after 2 h NOT 7 d

For infants and elderly: apply to scalp and face as well (avoid eyes and mouth)

New or increased pruritus

Mild, transient burning or stinging

 None IB3
     

Crusted Scabies

Apply QD for 7 d then twice weekly till cleared

      
Lindanea,d

S

(See footnote to table)

 Antiparasitic, GABA-gated chloride channel blocker

1% lotion;

Apply for 8 h, repeat in 7 d

Neurotoxicity, seizures, contact dermatitis

contraindicated in premature infants

 None IB3

Crotamitona

(FDA-approved for use in adults only)

S

≥2 mo of age

FDA pregnancy category C

 Antiparasitic, antipruritic agent

10% cream/lotion

Apply for 8 h on days 1, 2, 3, and 8

 Contact dermatitis, pruritus, skin rash, local hypersensitivity, skin irritation None III4-6
Precipitated sulfur

S

<2 mo of age

Safe for pregnant females

 Antiparasitic

5%-10% ointment

Apply to skin for 8 h on days 1, 2, and 3

 Irritant dermatitis None IA6-8

Benzyl Benzoate

(Not available in the United States)

 S, CS Antiparastic

10% lotion; 25% lotion

Apply for 24 h

 Skin irritation, increased eczematous reactions None III9,10
Spinosada

S

≥4 y of age

Antiparasitic

Act on GABA and nicotinic acetylcholine receptors

0.9% suspension

Apply to entire skin surface and wash off after 6 h. Repeat in 7 d

 Skin irritation, dry skin None IB11
Malathion

S

>1 y of age

 Antiparasitic, acetylcholinesterase inhibitor

0.5% lotion

Apply to dry skin and scalp. Leave in for 24 h, then rinse. Repeat in 7 d

 Skin irritation, conjunctivitis, chemical burn None III12
Ivermectin

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