Medications

Prescription permethrin (Elimite) cream or lotion is the most commonly used medicine to treat scabies. Unlike the more toxic lindane, permethrin is considered safe for infants as young as 2 months old.

• Only permethrin, crotamiton, and sulfur ointment are considered safe for treating children younger than age 2.
• Lindane is sometimes used as a secondary treatment for a defined group of people. It must only be used as a single application exactly as directed. Lindane is not recommended for babies, older adults, anyone who weighs less than 110 lb (49.9 kg), or people who have a weakened immune system.³ Lindane should also not be used for people who have widespread dermatitis or women who are pregnant or breast-feeding.⁴ Lindane shampoo and lotion are not available in California for treating lice or scabies.⁵
• Crusted (Norwegian) scabies (rare) often requires multiple treatments, sometimes with more than one medicine.
• Steroid creams, antihistamines (such as Benadryl), and, in severe cases, steroid pills can be used to relieve itching, but they do not kill scabies mites. Don't give antihistamines to your child unless you've checked with the doctor first.
• Persistent nodular scabies may be treated with injections of steroids into the nodules or (rarely) with coal tar products applied to the skin.

Most creams or lotions are applied to the entire body from the neck down. On infants, the medicine is also applied to the scalp, face, and neck, taking care to avoid the area around the mouth and eyes. The medicine usually is left on for 8 to 14 hours and then washed off.

Nonprescription medicines are not strong enough to kill the scabies mites.

Medication Choices

Prescription medicines used to treat scabies include:

• Permethrin cream 5% (Elimite), a standard first treatment for scabies. It usually cures scabies infestation after the first application.
• Lindane 1% (Kwell), which must be used exactly as directed to avoid dangerous side effects. Lindane is only used if your scabies persists after trying other medications or you are unable to use other treatments.⁶
• Sulfur ointment (precipitated sulfur) 5% to 10%, a milder and less effective medicine than permethrin or lindane, is sometimes used to treat infants and pregnant or breast-feeding women.
• Crotamiton 10% (Eurax), which is not often used to treat scabies because it does not dependably kill all the mites and their eggs.
• Ivermectin, an oral medication. Currently in the United States, treating scabies with ivermectin is considered an off-label use. More research is needed to confirm its effectiveness and to determine which people would benefit most from its use.² However, a doctor may prescribe it in certain situations, such as in combination with other medicines to treat people with severe cases of scabies.

You may also need to take an antibiotic if you develop a secondary skin infection.

What To Think About

When used correctly, lindane is considered a safe and effective treatment for scabies. With incorrect use or overuse, however, lindane can be dangerous and can permanently damage the central nervous system. If your doctor prescribes lindane to treat scabies, make sure you receive, understand, and follow detailed instructions for using it correctly.

Scabies treatment can fail:

• When the medicine is not applied properly. Carefully follow instructions for using scabies medications.
• If the medicine does not kill the scabies eggs. When the eggs hatch, a new infestation begins.
• When other members of the affected person's household are not treated.