Scabies Treatment: Medications and Lifestyle Changes

Scabies is caused by tiny mites called Sarcoptes scabiei. They spread through skin-to-skin contact, burrowing into the top layer of the skin to feed. This causes intense itching and a red, bumpy rash.

Treatment for scabies includes medication to kill the mites and deep cleaning to remove any lingering mites in the environment. 

It’s also essential to clean your environment thoroughly and ensure that everyone in your household, including sexual partners, receives treatment—even if they don’t have symptoms—to prevent reinfestation. 

If you have been diagnosed with scabies, you will use a medication called a scabicide to kill the scabies mites. Some treatments kill mites and eggs, while some only kill adult mites. In those cases, a second treatment can kill any new mites that have hatched since your last treatment.

Your healthcare provider will tell you exactly when and how to treat your scabies based on the medication they prescribe. No over-the-counter (OTC) medications have been approved to treat scabies. See a healthcare provider to get a prescription medication. 

Several topical medications treat scabies infestations, such as lotions, creams, liquids, and ointments. No matter the medication form, follow the same treatment process. Here are the steps:

1. Take a bath or shower before applying the medication.
2. Work the medication into clean, dry skin.
3. Apply it as thoroughly as possible, including the spaces between your toes, under your arms, and inside your belly button. Babies and older adults often need the treatment applied to their scalp and forehead, while adults and children over 2 years usually only need treatment from the neck down to the toes.
4. Never apply the medication to your face.
5. Put scabies medication on at bedtime and then rinse it off in the morning, leaving it on for at least eight hours. Instructions may vary based on the specific medication. 

Topical Medications

Here are some of the topical medications typically prescribed:

• Permethrin cream (5%): This is the most common prescription for scabies. You should leave it on for around 12 hours before removal. You’ll repeat this treatment a second time—one week after the first—to eliminate the infestation. Permethrin cream can treat scabies in everyone over the age of 2, including pregnant people.
• Spinosad liquid (0.9%): Spinosad is a relatively new treatment for scabies, approved in 2021. In recent studies, it appears to work as well as similar treatments for scabies in people over age 4, and you may only need to apply it once to eliminate the infestation. Because it’s still newly approved, it’s likely to be safe for pregnant people but may not be the first treatment offered if you’re expecting.
• Sulfur ointment (5-10%): This scabies treatment is messy and has an unpleasant odor, but it is the only treatment safe for children and babies under 2, so it’s often prescribed instead of permethrin for very young children. Your provider will likely instruct you to apply the sulfur ointment to your infant for three days, leaving it on for the full 24 hours in between applications.
• Crotamiton lotion or cream (10%): This medication is usually not prescribed as a frontline treatment because it doesn’t work as well as other options. However, it is approved by the United States Food and Drug Administration (FDA) for treatment and is considered safe for adults (but not children). Its use in pregnancy is likely to be safe but is unstudied. Crotamiton treatment typically involves applying the medication once and then again 24 hours later.

A few other scabies treatments exist but are either not approved by the FDA or are not available in the U.S. because of safety concerns—especially for pregnant people. These include benzyl benzoate lotion, malathion lotion, and lindane lotion.

Oral Medications

People sometimes need oral medication alone or in combination with a topical medication to treat scabies. The oral medication used is ivermectin, an antiparasitic drug. 

Ivermectin is prescribed for cases that don’t improve with other treatments, such as widespread scabies that are hard to treat with creams alone. It’s also used for crusted scabies, a more serious and contagious form.

There’s no consensus on the exact ivermectin dosage required to treat scabies, but it will generally include more than one dose of a 200-milligram ivermectin tablet. Your doctor might tell you to take two doses 14 days apart or several doses spread throughout two weeks.

Because of a lack of information about its safety, experts usually don’t recommend ivermectin for pregnant people or children weighing less than 33 pounds.

Wash all items that have come into direct contact with your skin. Cleaning won’t cure scabies without medications, but it’s still essential for treatment to be effective. Skipping this step increases your chances of becoming reinfected with scabies.

Here is an overview of what you should do:

• Wash all recently worn clothing and any used bedding or bath towels in hot water
• Use a dryer to dry these items on the highest heat setting.
• Take items to the dry cleaner if you cannot wash or dry them
• Seal items that cannot be washed or dry cleaned in a plastic bag for at least 72 hours; scabies mites typically can’t survive without a human host for more than two or three days
• Vacuum all rugs, carpeting, and any furniture with upholstery

Scabies is uncomfortable, and the rash can be unsightly, but it is not a serious or life-threatening health condition. The only potential complication is skin infection caused by persistent scratching of the rash.

Scabies is highly curable, though people sometimes need to repeat treatment if they did not eliminate their exposure to scabies after the initial treatment. In other words, any remaining mites in your environment—on your clothes or bedding—could reinfect you. Reinfection can also happen via contact with people who did not receive treatment at the same time as you. 

As long as you reach out to a healthcare provider for treatment, you won’t have to live with scabies for very long. It takes just a few weeks for symptoms to clear up completely. Here are some ways to manage scabies while you wait for the medication to work:

• Avoid going to work or school until you have had your first treatment. You can return to normal activities after your first overnight treatment.
• Ask your provider if there are medications you can use to relieve the itching, like antihistamines.
• Ensure everyone in your household has been treated for scabies, even if they don’t have symptoms. Notify any sexual partners or anyone you recently had close, skin-to-skin contact with.
• Contact your provider if you still have symptoms or develop a new rash after two weeks of treatment. You should also reach out if you have signs of a skin infection, like redness, swelling, pain, or discharge.