Scabies Treatment

How do you get rid of them? Currently the most common treatment in the westernized world is a 5% permethrin cream that is usually applied to from the neck down and left on over night. Getting rid of scabies also requires washing all used clothes and bedding in hot water, and thoroughly drying them on high heat in a machine dryer. Perhaps what needs to be stressed the most about treating for scabies, is that everybody who has had significant exposure to scabies needs to be treated, or else the risk of re-infection is usually quite high.

When to treat

Treating in the daytime - I think this is a good way to have your treatment fail. It's so easy to wash your hands, and forget to reapply the treatment, or perhaps exert yourself and sweat it off. Do yourself a favor (and everybody else) and treat at night.

A decision about when to treat should consider the following:

Who to treat

Be aware! - that permethrin is extremely toxic to aquatic and amphibious life.

Mass treatment

Treatment of an entire facility (school, workplace, care facility etc.) should be considered when: Because it takes time, money, and energy to treat for scabies, it's important, when a lot of people may need to be treated, to attempt to verify a diagnosis of scabies by a test*. If multiple testing results are negative, and symptoms still resist among a number of patients two weeks after treatment, then an alternative diagnosis to scabies should be considered.

Note: mass treatment should include household members of those who have had hands-on contact*, or substantial exposure* to, to an infected individual or environment


Fingernails - This is an important place to treat. It's a natural place for scabies to be: you scratch, and pick them up under your finger nails. Make sure you clip them or apply scabicide underneath them using a soft brush (such as an old toothbrush). Children and treatment - I believe that most children need to be supervised while putting on treatment. Success depends on meticulous application, and many children just don't have the mental focus to apply a lotion thoroughly.

Tip: Inside seemingly empty scabicide containers there's still quite a bit of lotion. Don't throw these containers out. You can cut the containers open and use the residual lotion to re-treat areas where lotion may have come off. If you have enough empty containers they might even contain enough lotion to treat a child or infant.
The following instructions apply to the use of a 5% permethrin cream. Success of permethrin cream, when properly applied, is 90-95% effective.

After treatment

It's hard to tell if you've gotten rid of scabies! This is one of the most frustrating aspects of scabies. I can only emphasize that the symptoms of scabies ought to gradually decline over the 7-10 days after treatment. A strong resurgence of itching or visual symptoms usually means that the treatment has failed. Important! Symptoms may persist or even intensify after treatment. Symptoms should improve gradually within 7-10 days after treatment. Persistent symptoms are due to the body's reaction to the dead, or dying mite. If symptoms haven't improved within this time, it's likely that the treatment has failed, reinfection has occurred, or the original diagnosis of scabies was incorrect. Consider either re-treating or getting another diagnosis.

Antihistamines and topical steroids creams will minimize resistant post-treatment symptoms of scabies; however, minimizing symptoms can mask treatment failure or reinfection; therefore, in order to gain evidence for treatment success or failure, a temporary break from using antihistamines and steroids should be seriously considered a week after treatment. Also, it should be noted that steroids can worsen a scabies infection*.

Employees and students may return to school or work after finishing treatment; however, before returning, it's a good idea to inquire if everybody who was supposed to treat have actually followed through on their treatment.


According to the studies I've read, the major mode of transmission for scabies is via person to person contact, and transmission from the environment a minor risk in comparison.

I'm not sure I buy this. Perhaps it's just my natural paranoia, but my intuition is that environment plays significant role in transmission, especially in the cool moist climate I live in. I'd like to see more studies about environmental transmission.

Mites are susceptible to dehydration, so their survival time is dependent on humidity and temperature. Several studies have shown mites can survive 2-5 days at normal indoor temperatures and humidity; however, under these conditions a mite is usually only able to infect for only the first 1-2 days. Under higher humidity and/or cooler temperatures, mites may survive and be infectious for longer than 1-2 days.


Laundry - I think it's a good idea after doing laundry, to use as little of it as possible for the 7-10 days after treatment. Keep as much in isolation as possible. This will save you a lot of work if you have to re-treat. Water temperature of wash - Although high water temperature has been recommended numerous times in my reading, and that's why I include the recommendation here, it seems to me that a thorough drying at high heat should be more than sufficient to kill scabies.

Personal items

Cleaning the environment

Covering upholstered furniture - It's a hassle, and unsightly, but it's probably a good idea. Again, this is more important in moist conditions than dry ones. Vacuuming furniture thoroughly and, perhaps, turning the heat up (drying scabies to death) might be sufficient, but you can't be certain. Flipping your mattress - this is to get any mites that might have escaped vacuuming further away from you. Mites move pretty well on the body (about 2.5 cm a minute), but I'd imagine fabric really slows them down. Also, the more energy they have to spend on moving, the sooner they'll die. Ideally, the environment should be cleaned both before and after treating for scabies. However, since many people don't have the time and energy to do this, it seems reasonable to do the majority cleaning after treatment has completed; this minimizes the possibility of spreading scabies to the environment while cleaning it, and then catching them again from that same environment after treating. Bathrooms and bedrooms are an exception, and should be cleaned before and after treatment, because they are likely sites for transmission immediately after removing the treatment by bathing. The hard truth - given that permethrin is 90-95% effective, and that the environment isn't a super effective way to transmit scabies, then, the most likely way for a treatment to fail - and my experience backs this up - is by reinfection from somebody else. If your treatment fails, especially if it fails two, or three times (not uncommon), you may find yourself becoming very anti-social until your confidence in your environment has been restored.

Reasons for Treatment Failure


Reinfestation is usually due to the following reasons:

Inadequate treatment application

Scabicidal resistance