In Health

Scabies Treatment and Management

scabies treatment

Scabies is a contagious skin disorder characterized by severe itchiness, blotchy skin rash that leads to formation of tiny papules which are pus-filled blisters, the formation of grey, red or brown mite burrows and intense scratching. Scabies infestation could lead to aggravation of pre-existing skin conditions like acne, eczema and psoriasis. You should seek scabies treatment as soon as symptoms appear or right after you come in contact with an infested patient either through direct contact or sexual intercourse. Although it is not a very serious condition, scabies might be very irritating and if left untreated, the mites would stay in your skin forever.

Medication Plan for Scabies Treatment:

Scabies treatment plan is comprised of two goals. The first step is eliminating the mites using a potent scabicide. The second step is symptomatic treatment of itchiness, hypersensitivity reaction to the mites, swelling, redness or latent infection.

There’s no approved or tested over the counter scabies treatment. Only prescription medications are effective. Your GP assessment of your infestation condition is the most important step towards making it better and also recognizing whether it was a regular infestation or if bacterial infection has been involved.

Scabies treatment in humans differs when dealing with the regular scabies rash and the crusted “Norwegian scabies”.

Scabies treatment follows the following guidelines:

  1. First line treatment mite killer: Permethrin 5% cream is applied from the neck down to clean, dry skin and left overnight. In the morning, permethrin is washed off thoroughly and the skin is dried with a clean towel. This scabies treatment cream is the safest and most effective choice for eliminating mites.
  2. Second line treatment mite killer: Lindane 1% lotion or 30 g of cream is used on clean, dry skin and applied from neck down. However, it shouldn’t be left overnight or it would cause seizures. Lindane 1% lotion should be washed off after 8 hours or less. When applying lindane, stay away from the eyes and mucous membranes. You should never use Lindane if you are pregnant or breastfeeding.
  3. Scabicidal agent and antiparasitic: Ivermectin is the only oral medication given for treatment of scabies. It is not FDA-approved for scabies treatment but it is recommended in cases resistant to topical scabicidal agents and for immunocompromised patients.
  4. Third line treatment scabicidal agents for rash and pruritus: Crotamiton 10% lotion or 10% cream is only given for treatment in case of failure of Lindane or Permethrin. It is highly toxic so it shouldn’t be applied to sensitive skin or open sores and it shouldn’t be used in children.
  5. Antihistamines for treatment of rash: Cetrizine or diphenhydramine are potent antihistaminic agents for scabies treatment. They relieve the itchiness and reduce the scratching that might lead to bacterial infection. They are prescribed alongside scabicidal agents. They could be used as pills or topical agents. Your GP would consider the most effective form of antihistamine whether it was the sedative type (diphenhydramine, chlorpheniramine) or the second-generation, non-sedative type (cetrizine).
  6. Treatment for redness, swelling and itch: Pramoxine/hydrocortisone is a combination medication of a local anesthetic and a corticosteroid. It is very effective to control severe itching and scratching. Pramoxine/hydrocortisone is available in the form of ointment, cream or gel.
  7. Treatment for concomitant bacterial infection: Topical agents like mupirocin treats secondary bacterial infections in infested lesions.

scabies treatment

Tips for Successful Scabies Medication Treatment:

  1. Read the prescription leaflet that comes with every medication. Pay great care to side effects and the medication’s safety profile. When applying creams or ointments, read carefully how to apply the topical agents. Some treatments for scabies should cover the whole body including the head and scalp, while others should only be applied from the neck down.
  2. Re-apply cream to the hands or any area of the body after washing them with water. Always remember to apply the lotion between your fingers and underneath the nails.
  3. Always trim your nails and clean under them to make sure there are no mites or eggs stuck underneath the nailbeds.
  4. If your baby is infested with scabies, put mittens to stop him/her from licking the lotion off.
  5. If you are a breastfeeding mother, wash off your nipples from the lotion before breastfeeding. Re-apply afterwards.

Norwegian Scabies Treatment and Prevention:

Scabies could be manifested in a severe, aggravated form called “Norwegian Scabies”. The reason behind this name is that the first case of this particular infestation was reported in Norway in the mid 19th century. In this form, there is an even greater risk of contagiousness due to the presence of thousands or millions of mites (hyperinfestation) on the infested person’s skin. People who get Norwegian scabies are those who suffer from a weakened immune system, the malnourished, the elderly, people with chronic illnesses, patients with autoimmune diseases, people who undergo chemotherapy, people with neurological disorders that mask itching sensation and thus their infestation worsens, uneducated people who take longer to recognize they are infested and seek medical treatment, people who take prolonged treatment courses of steroids and people with learning disabilities (e.g. Down’s syndrome).

Norwegian scabies is also called crusted scabies because it is characterized by thick, warty crusts that cover the whole body. Fingernails are thickened and discolored. Unlike regular scabies, there is no severe itching which causes a delay in discovery of the disease and complicates the treatment. Facial skin may flake off. In extreme cases, hair loss occurs.

Norwegian scabies treatment requires a very potent scabicide. Ivermectin is the first line of treatment. Single dose of ivermectin is not enough and multiple doses are required for effective elimination of the thousands of mites that live inside the host’s skin. Due to the high level of toxicity, the patient should be monitored carefully by the GP during the treatment course.

Home Remedies and Natural Recipes for Scabies Treatment:

Many people seek natural scabies treatment. You should always visit a GP, though, if you suspect that you have scabies. You might want to accompany scabicidal medications with natural remedies to soothe your itchiness and calm down your rashy skin.

For optimal scabies treatment using home remedies, use neem oil to kill the mites. Neem oil has a natural repellent odor to insects in general without harming humans. It disrupts the reproductive cycle of scabies mites by altering their hormones and acting like a natural contraceptive. Prepare a neem oil tincture and brush gently against affected areas.

Zinc paste is also very effective as a natural scabies remedy. Apply the paste to all irritated areas of the skin. Mix turmeric with the zinc paste for extra soothing of the itching as well as additional anti-parasitic action. This natural remedy is also perfect for treating the underlying secondary bacterial skin infections and to prevent opportunistic fungal pathogens from growing on the skin.

Hot water baths filled with cayenne powder are also effective in burning the scabies mites without harming the body. You should remember to cover your eyes while taking this bath, though, because of the harmful effect of cayenne on the eyes.
scabies treatment

Tips for Successful Home Scabies Treatment:

  1. Shower and dry your body with a clean towel. Always wait till your body cools off before applying the scabicidal cream or lotion.
  2. All house members should be treated from scabies, not just the infested person. If you acquired scabies from work, for example: nursing homes, consider treating every member of the facility, patients and healthcare workers like.
  3. You should moisten your hair and skin very often. Use cocoa butter or petroleum jelly on the skin of the hands, feet, knees and elbows. Apply moisturizing natural hair products such as hot oil baths to prevent recurrence of scabies.
  4. Mop the floors constantly using a disinfectant. Clean bathroom and kitchen surfaces with water and soap followed by a detergent. Bleach the mop after each cleaning session.
  5. Vacuum floors, carpets, furniture, car interiors, rugs and bedding. Discard vacuum bags after finishing.
  6. Steam-clean living areas or furniture using borax powder. When spreading borax, wear a high quality respirator mask.
  7. Wash all clothes, bed linens and towels at 50°C or above. After washing, use high heat drying instead of air drying to make sure of eliminating the mites. Add vinegar or pine-scented cleaner to every pile of clothing in the washing machine.
  8. Store non-washable objects (stuffed animals, brushes, combs, shoes, gloves, hats, robes, coats, wetsuits and swimming suits) away from the house and keep in vacuum-seal bags for about two weeks.
  9. Spray down mattresses with water-diluted pine cleaner or tea tree oil cleaner.
  10. Wear disposable gloves when stripping beds. Change beds daily and put bed linens, mattresses, comforters and bedsheets in the dryer every night.

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