There are a number of creams that treat scabies. In general, the principle is the same for all of them. The cream must be applied from the hairline down to the toes and left on overnight — a minimum of 8 hours but up to 14 hours. The entire surface of the body needs to be covered, including between the fingers and toes, under the fingernails, and in the crease of the buttocks. The only places that do not get covered with cream are the center of the face, the scalp, and the female genitals (the penis and scrotum should be treated). In the morning, bathe your child to clean off all the cream. Do not limit the cream to the areas with the rash because the mites can crawl elsewhere. Sometimes the treatment is repeated after 7 to 10 days.
The most commonly used medication is 5 percent permethrin (Nix or Elimite). This cream is generally very well tolerated, although it may cause some stinging or burning. In the past, lindane was a commonly used alternative. However, lindane has been found to have neurological side effects, specifically seizures, when overapplied, so it has been pulled off the market in some states. In extreme cases, an oral medicine such as ivermectin may be used for severe cases of scabies. Oral medication is generally not used to treat scabies in young children.
Everyone who has had close contact with an infected person should be treated for scabies. This means that the entire family will probably be sleeping slathered in cream for at least one night. Be sure to treat the family and implement all household cleaning measures at the same time. This will minimize the risk that one person will continue to be infested.
To help control the itching, antihistamines such as diphenhydramine (Benadryl), loratadine (Claritin), cetirizine (Zyrtec), or hydroxyzine (Atarax) can be given. It is safe to give these medications at the same time you are using permethrin. Diphenhydramine is available in both creams and oral preparations. The oral form should be used because it is much more effective and it won’t physically interfere with the actual scabies treatment.
What are the possible complications?
Itching often lasts for weeks after treatment. This is normal — it does not mean that the mites are still alive. Unless a new rash appears, do not worry that treatment was ineffective.