Scabies Treatment

Scabies is caused by the Sarcoptes scabiei mite burrowing into the skin, triggering an intense delayed hypersensitivity reaction. It spreads through prolonged skin-to-skin contact — including sexual contact and household exposure. Brief contact like handshakes rarely transmits it.

Itching after successful scabies treatment is expected and can last 2–4 weeks — it reflects the immune response to dead mites and their remnants, not treatment failure or re-infestation. Antihistamines and low-potency topical steroids can help manage post-treatment itch.

Yes — simultaneous treatment of all household members and close contacts (including sexual partners) is essential, regardless of whether they have symptoms. Treating the index case alone without treating contacts leads to re-infestation.

Wash clothing, bedding, and towels used in the 3 days before treatment in hot water and dry on high heat. Items that can't be washed should be sealed in a plastic bag for 72 hours. Extensive environmental fumigation is unnecessary — mites don't survive more than 2–3 days off a human host.

Permethrin 5% cream is the first-line treatment and is very well tolerated — mild skin irritation is occasionally reported. Oral ivermectin is effective for widespread or crusted scabies and is generally well tolerated. Lindane is no longer recommended due to neurotoxicity risk.