A number of medications are effective in treating scabies; however, scabies treatment must often involve the entire household or community to prevent reinfection. Options to improve itchiness include antihistamines.
Permethrin is the most effective treatment for scabies, and is the treatment of choice. It is applied from the neck down, usually before bedtime, and left on for about eight to 14 hours, then showered off in the morning. One application is normally sufficient for mild infections. For moderate to severe cases, another dose is applied seven to 14 days later. Permethrin causes slight irritation of the skin, but the sensation is tolerable. The medication, however, is the most costly of topical treatments.
Ivermectin is an oral medication shown by many clinical studies to be effective in eradicating scabies, often in a single dose. It is the treatment of choice for crusted scabies, and is often used in combination with a topical agent. It has not been tested on infants and is not recommended for children under six years of age.
Topical ivermectin preparations have been found to be effective for scabies in adults, and are attractive due to their low cost, ease of preparation, and low toxicity. It has also been useful for sarcoptic mange (the veterinary analog of human scabies).
Other treatments include lindane, benzyl benzoate, crotamiton, malathion, and sulfur preparations. Lindane is effective, but concerns over potential neurotoxicity has limited its availability in many countries. It is approved in the United States for use as a second-line treatment. Sulfur ointments or benzyl benzoate are often used in the developing world due to their low cost; 10% sulfur solutions have been shown to be effective, and sulfur ointments are typically used for at least a week. Crotamiton has been found to be less effective than permethrin in limited studies. Crotamiton or a sulfur preparation is often recommended instead of permethrin for children, due to concerns over dermal absorption of permethrin.