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Scabies - Management
What drug treatments can I recommend for itching?
- Treat itching with topical crotamiton.
- Alternatively, consider using topical hydrocortisone 1% to help reduce itch and inflammation.
- Avoid corticosteroid creams if the diagnosis is not certain, as they may mask signs and symptoms of other skin conditions, making diagnosis more difficult.
- Consider an oral sedating antihistamine (e.g. chlorphenamine or hydroxyzine) at night if the itch is interfering with sleep.
Clarification / Additional information
- Apply crotamiton 2–3 times a day. Crotamiton is licensed for children under 3 years old for once a day application only.
- Apply topical hydrocortisone sparingly to the affected area once or twice a day for no longer than 7 days [BNF 53, 2007].
- If creams for itching need to be applied during the application time of the insecticide, allow the insecticide to disappear into the skin or dry, before the cream or lotion for itch is applied.
Basis for recommendation
Topical treatments
- Crotamiton cream or lotion has soothing qualities and may help to relieve itch, although no controlled studies have been published that assess its efficacy. It is licensed for the relief of itching caused by scabies.
- CKS was unable to identify any trial evidence for topical corticosteroids, but they are widely used for the treatment of scabies-related itch [BNF 53, 2007].
Oral antihistamines
- There is limited evidence that oral antihistamines are effective in treating pruritus.
- Results from a review of 16 randomized controlled trials and other studies (n = 803) suggest that neither first- nor second-generation antihistamines offer relief from itch in conditions such as atopic dermatitis [Klein and Clark, 1999].
- However, it may be useful to give a sedating oral antihistamine at night for temporary help with sleeping, to break the itch-scratch-itch cycle. Hydroxyzine is licensed for use in pruritus but chlorphenamine is not (off-label use).
- Itching is worse at night when the patient is warm.
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