- Beth G Goldstein, MD
Beth G Goldstein, MD
- Adjunct Clinical Assistant Professor
- Department of Dermatology
- University of North Carolina at Chapel Hill
- Adam O Goldstein, MD, MPH
Adam O Goldstein, MD, MPH
- Department of Family Medicine
- University of North Carolina at Chapel Hill
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Ted Rosen, MD
Ted Rosen, MD
- Section Editor — Infections and Infestations
- Professor, Department of Dermatology
- Baylor College of Medicine
Scabies is a cutaneous infestation caused by the mite Sarcoptes scabei. Classic scabies is typically characterized by an intensely pruritic eruption with small, often excoriated, erythematous papules in sites such as the fingers, wrists, axillae, areolae, waist, genitalia, and buttocks. Crusted scabies, a less common clinical variant, typically presents with scaly, crusted, fissured plaques and primarily occurs in immunocompromised individuals. (See "Scabies: Epidemiology, clinical features, and diagnosis".)
The successful management of scabies involves the eradication of mites from the affected person, management of associated symptoms and complications, assessment for additional individuals who may require treatment, and implementation of measures to minimize transmission and recurrence of infestation. Factors such as the clinical variant, patient characteristics, and the setting of infestation influence the selection of interventions.
The management of scabies will be reviewed here. The clinical manifestations and diagnosis of scabies are discussed separately. (See "Scabies: Epidemiology, clinical features, and diagnosis".)
ERADICATION OF INFESTATION
The approach to the eradication of scabies mites is dependent upon the clinical presentation (classic, crusted, or endemic scabies) and patient population (see 'Special populations' below). Treatment of both the patient and close personal contacts is suggested to prevent recurrent infestation. (See 'Contacts and environment' below.)
Classic scabies — The availability of antiscabietic agents for classic scabies varies worldwide [1,2]. Topical permethrin and oral ivermectin are the most common first-line treatments in the United States, United Kingdom, and Australia . Benzyl benzoate, topical sulfur, crotamiton, lindane, and topical ivermectin are examples of other treatments. (See 'Other agents' below.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Salavastru CM, Chosidow O, Boffa MJ, et al. European guideline for the management of scabies. J Eur Acad Dermatol Venereol 2017; 31:1248.
- Executive Committee of Guideline for the Diagnosis and Treatment of Scabies. Guideline for the diagnosis and treatment of scabies in Japan (third edition): Executive Committee of Guideline for the Diagnosis and Treatment of Scabies. J Dermatol 2017; 44:991.
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- www.cdc.gov/parasites/scabies/index.html (Accessed on August 21, 2017).
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- Romani L, Whitfeld MJ, Koroivueta J, et al. Mass Drug Administration for Scabies Control in a Population with Endemic Disease. N Engl J Med 2015; 373:2305.
- www.cdc.gov/parasites/scabies/health_professionals/meds.html (Accessed on May 04, 2016).
- Macotela-Ruíz E, Peña-González G. [The treatment of scabies with oral ivermectin]. Gac Med Mex 1993; 129:201.
- Usha V, Gopalakrishnan Nair TV. A comparative study of oral ivermectin and topical permethrin cream in the treatment of scabies. J Am Acad Dermatol 2000; 42:236.
- Twum-Danso NA. Serious adverse events following treatment with ivermectin for onchocerciasis control: a review of reported cases. Filaria J 2003; 2 Suppl 1:S3.
- Gardon J, Gardon-Wendel N, Demanga-Ngangue, et al. Serious reactions after mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet 1997; 350:18.
- Barkwell R, Shields S. Deaths associated with ivermectin treatment of scabies. Lancet 1997; 349:1144.
- Coyne PE, Addiss DG. Deaths associated with ivermectin for scabies. Lancet 1997; 350:215.
- Diazgranados JA, Costa JL. Deaths after ivermectin treatment. Lancet 1997; 349:1698.
- Chosidow O. Clinical practices. Scabies. N Engl J Med 2006; 354:1718.
- Chhaiya SB, Patel VJ, Dave JN, et al. Comparative efficacy and safety of topical permethrin, topical ivermectin, and oral ivermectin in patients of uncomplicated scabies. Indian J Dermatol Venereol Leprol 2012; 78:605.
- Goldust M, Rezaee E. The efficacy of topical ivermectin versus malation 0.5% lotion for the treatment of scabies. J Dermatolog Treat 2013.
- Ahmad HM, Abdel-Azim ES, Abdel-Aziz RT. Clinical efficacy and safety of topical versus oral ivermectin in treatment of uncomplicated scabies. Dermatol Ther 2016; 29:58.
- www.accessdata.fda.gov/drugsatfda_docs/label/2003/06927slr030,09112slr021_eurax_lbl.pdf (Accessed on August 22, 2017).
- Marlière V, Roul S, Labrèze C, Taïeb A. Crusted (Norwegian) scabies induced by use of topical corticosteroids and treated successfully with ivermectin. J Pediatr 1999; 135:122.
- Corbett EL, Crossley I, Holton J, et al. Crusted ("Norwegian") scabies in a specialist HIV unit: successful use of ivermectin and failure to prevent nosocomial transmission. Genitourin Med 1996; 72:115.
- Taplin D, Meinking TL. Treatment of HIV-related scabies with emphasis on the efficacy of ivermectin. Semin Cutan Med Surg 1997; 16:235.
- Huffam SE, Currie BJ. Ivermectin for Sarcoptes scabiei hyperinfestation. Int J Infect Dis 1998; 2:152.
- Roberts LJ, Huffam SE, Walton SF, Currie BJ. Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature. J Infect 2005; 50:375.
- Marks M, Taotao-Wini B, Satorara L, et al. Long Term Control of Scabies Fifteen Years after an Intensive Treatment Programme. PLoS Negl Trop Dis 2015; 9:e0004246.
- Kearns TM, Speare R, Cheng AC, et al. Impact of an Ivermectin Mass Drug Administration on Scabies Prevalence in a Remote Australian Aboriginal Community. PLoS Negl Trop Dis 2015; 9:e0004151.
- Bécourt C, Marguet C, Balguerie X, Joly P. Treatment of scabies with oral ivermectin in 15 infants: a retrospective study on tolerance and efficacy. Br J Dermatol 2013; 169:931.
- Müllegger RR, Häring NS, Glatz M. Skin infections in pregnancy. Clin Dermatol 2016; 34:368.
- Johnston G, Sladden M. Scabies: diagnosis and treatment. BMJ 2005; 331:619.
- Chung SD, Wang KH, Huang CC, Lin HC. Scabies increased the risk of chronic kidney disease: a 5-year follow-up study. J Eur Acad Dermatol Venereol 2014; 28:286.
- Suh KS, Han SH, Lee KH, et al. Mites and burrows are frequently found in nodular scabies by dermoscopy and histopathology. J Am Acad Dermatol 2014; 71:1022.
- Karthikeyan K. Treatment of scabies: newer perspectives. Postgrad Med J 2005; 81:7.
- Mittal A, Garg A, Agarwal N, et al. Treatment of nodular scabies with topical tacrolimus. Indian Dermatol Online J 2013; 4:52.
- Almeida HL Jr. Treatment of steroid-resistant nodular scabies with topical pimecrolimus. J Am Acad Dermatol 2005; 53:357.
- Zawar V, Pawar M. Liquid nitrogen cryotherapy in the treatment of chronic, unresponsive nodular scabies. J Am Acad Dermatol 2017; 77:e43.
- Chambliss ML. Treating asymptomatic bodily contacts of patients with scabies. Arch Fam Med 2000; 9:473.
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- www.cdc.gov/parasites/scabies/health_professionals/institutions.html (Accessed on August 21, 2017).
- ERADICATION OF INFESTATION
- Classic scabies
- - First-line therapies
- Oral ivermectin
- - Other agents
- Crusted scabies
- Endemic scabies
- Special populations
- - Children
- - Pregnant women
- Assessment for cure and treatment failure
- SYMPTOMS AND COMPLICATIONS
- Secondary infection
- CONTACTS AND ENVIRONMENT
- Community setting
- Institutional setting
- RETURN TO WORK OR SCHOOL
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS