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Scabies - Management
Overview of management

  • Initial presentation:
    • Treat simultaneously (within 24 hours) all members of the household, close contacts, and sexual contacts with a topical insecticide (even in the absence of symptoms).
    • Apply insecticide twice with applications one week apart.
      • Use permethrin 5% dermal cream as a first-line treatment.
      • Use malathion 0.5% aqueous liquid if permethrin is inappropriate (e.g. if the person has an allergy to chrysanthemums).
    • Mites on clothes, bed linen, or towels can be killed by machine washing (at 50°C or above), on the day of application of the first treatment. For alternative methods see Managing scabies.
    • Consider symptomatic treatment for itching.
    • Treat associated eczema — see the CKS topic on Eczema - atopic.
  • If itch persists 4 weeks after the second application of insecticide:
    • Re-examine the person to confirm that the diagnosis is scabies.
    • Consider alternative diagnoses.
    • Consider the possibility that treatment failure has occurred. See Actions in treatment failure.
    • If re-treatment is indicated ensure that all members of the household, close contacts, and sexual contacts are identified and re-treated simultaneously.
  • Refer if:
    • The diagnosis is in doubt, or after two treatment failures.
    • There is a history of risk behaviour for sexually transmitted infections.
    • There is an outbreak of scabies in an institution (e.g. school, prison, or nursing home): report to the Health Protection Agency.
  • Seek specialist advice for:
    • Children under 2 months of age (e.g. from a paediatric dermatologist).
    • The management of crusted scabies (e.g. from a consultant dermatologist).

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