Scabies is a common skin infestation caused by tiny parasitic mites, Sarcoptes scabiei var. hominis, that burrow into the top layer of human skin. This burrowing activity leads to intense itching, often worse at night, and a pimple-like rash. While not a serious condition, treatment is necessary to eradicate the mites, alleviate uncomfortable symptoms, and prevent further spread.
Medications for Scabies on Skin
The primary approach to eliminating scabies involves prescription medications applied to the skin or taken orally. Over-the-counter products are not effective for treating human scabies, and medical advice is needed for proper diagnosis and treatment.
Permethrin cream, a 5% concentration, is the most common and effective first-line treatment. This topical medication works as a neurotoxin, disrupting the nerve cells of the mites, leading to their paralysis and eventual death. It is applied to the entire body from the neck down and left on for 8 to 14 hours before being washed off.
For more severe cases, such as crusted scabies, or when topical treatments are unsuitable or have failed, an oral medication like ivermectin may be prescribed. Ivermectin is an anti-parasitic pill taken as a single dose, with a second dose recommended 7 to 14 days later to ensure all newly hatched mites are killed. While effective and recommended in guidelines, it is not specifically FDA-approved for scabies treatment in the U.S. Other topical options, such as crotamiton lotion or sulfur ointment, exist but are often second-line treatments.
While some individuals may search for “sprays” to kill scabies, medically recommended treatments for human skin are primarily creams, lotions, or oral medications. These prescribed formulations are designed to effectively penetrate the skin where the mites reside.
Treating Household Items
Treating the environment is a necessary step to prevent re-infestation, as scabies mites can survive off the human body for a limited period, 2 to 3 days. Thorough cleaning of household items helps eliminate any mites that may have fallen off an infested person.
All clothing, bedding, and towels used by an infested person in the 2 to 3 days before treatment should be machine washed. Using hot water, at least 122°F (50°C), and drying on a hot cycle for at least 30 minutes effectively kills mites and their eggs. Items that cannot be laundered, such as stuffed animals or certain shoes, can be sealed in a plastic bag for at least 72 hours to starve the mites.
Regular vacuuming of carpets, rugs, and upholstered furniture is also recommended to remove mites and eggs from these surfaces. After vacuuming, discard the vacuum bag or clean the canister to prevent re-release of mites. While some insecticidal sprays for the environment exist, they are not necessary for routine scabies infestations in the home. Thorough cleaning and isolating non-washable items are sufficient, as mites do not survive long without a human host.
Safe and Effective Application
Correct application of prescribed treatments is important for successful scabies eradication. Topical medications are applied to cool, dry skin from the neck down to the soles of the feet, ensuring all skin folds, such as between fingers and toes, under nails, and in the armpits, are covered. For infants and very young children, the medication may also need to be applied to the head, face, and neck. The medication should remain on the skin for 8 to 14 hours before being washed off.
After the initial treatment, a second application is required 7 to 14 days later. This second dose targets any mites that may have hatched from eggs that survived the first treatment, as most medications do not kill eggs. Itching may persist for several weeks after successful treatment, as this is an allergic reaction to dead mites and their byproducts remaining in the skin.
To prevent re-infestation, all close household contacts and sexual partners should be treated simultaneously, even if they do not show symptoms. Seeking medical attention for diagnosis, prescription, or if symptoms persist or worsen after treatment is advisable.