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Scabies - Management
How should I manage someone presenting with scabies?

  • Simultaneously (within 24 hours) treat all members of the household, close contacts, and sexual contacts with a topical insecticide (even in the absence of symptoms).
    • Encourage the family not to delay treatment.
    • Pregnant or breastfeeding women should also be treated with an insecticide.
  • Apply the insecticide twice, with applications one week apart.
  • Consider symptomatic treatment for itching:
    • Advise the person that itching may take several weeks to resolve.
  • Treat associated eczema — see the CKS topic on Eczema - atopic.
  • Treat scabies that has become infected with an antibiotic.
  • Machine wash (at 50°C or above) clothes, towels, and bed linen, on the day of application of the first treatment.
  • Advise the individual to avoid close body contact with others until their partners and close contacts have been treated.
Clarification / Additional information
  • Keep any items of clothing that cannot be washed in plastic bags for at least 72 hours to contain the mites until they die.
  • Pressing clothes with a warm iron, dry cleaning, or putting items in a dryer on the hot cycle for 10–30 minutes is also effective.
  • It is not necessary to fumigate living areas or furniture, or to treat pets.
Basis for recommendation
  • These recommendations are based on expert advice from the published medical literature [HPA, 2005; Johnston and Sladden, 2005; Fox and Usatine, 2006].
  • It is important that all contacts (symptomatic and asymptomatic), including members from the same household, are treated on the same day:
    • Scabies is highly contagious and there is a latent period before symptoms develop.
    • Simultaneous treatment is important as this minimizes the chances of reinfestation from an untreated contact.
  • The recommendation for two applications, 7 days apart, is an unlicensed use of permethrin, and is different to the packaging information which states that a single application is sufficient. Malathion is now licensed as a course of two applications of insecticide 7 days apart [ABPI Medicines Compendium, 2007].

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