Scabies Treatment Protocol: Eliminating Mites & Preventing Reinfestation

Scabies (caused by Sarcoptes scabiei var. hominis) requires simultaneous treatment of the patient, close contacts, and environment.

First-Line Treatment

• Permethrin 5% cream: Apply neck-to-toes (including nails, genitalia, intertriginous areas), leave 8–14 hours, rinse. Repeat in 7 days. Safe in pregnancy/children >2 months.
• Alternative: Ivermectin 200 µg/kg PO (single dose, repeat in 7–14 days). Preferred for crusted scabies, institutional outbreaks, or permethrin failure. Not for pregnancy/children <15 kg.

Environmental Decontamination

• Machine wash (hot water ≥50°C/122°F) and hot-dry all clothing, bedding, towels used in last 72 hours.
• Non-washable items: seal in plastic bags ×72 hours (mites die without host).
• Vacuum carpets, upholstery, mattresses; discard vacuum bag.

Contact Management

Treat all household members and sexual contacts simultaneously, even if asymptomatic. Incubation: 2–6 weeks (first infestation); 1–4 days (reinfestation).

Special Situations

• Crusted (Norwegian) scabies: Hyperinfestation; highly contagious. Requires combination topical + oral ivermectin (multiple doses), keratolytics, isolation precautions.
• Infants/Young Children: Apply permethrin to scalp, face, ears (avoid eyes/mouth).
• Pregnancy: Permethrin preferred; ivermectin contraindicated.

Post-Treatment

• Itch may persist 2–4 weeks (post-scabetic eczema); treat with topical steroids/emollients.
• Re-evaluate at 2 and 4 weeks; retreat if new burrows/lesions appear.

Resistance to permethrin is emerging; ivermectin remains effective. Public health notification for institutional outbreaks.