- Sulphur has been used since around 25 AD to treat Scabies. Bar soap is commercially available with sulfur in the ranges of 1%-10% to kill scabies. 6% or above is recommended. Wash the whole body at least once daily for 4 consecutive days. And although supposedly minimally effective it is still recommended that all clothing, bed linen and blankets be washed in hot water and dried in high heat and then treated with Permethrin.
- Permethrin 5% is topical medication of choice. Toxicity may resemble allergic reactions. It is usually applied to the skin before bedtime and left on for about 8 to 14 hours, then showered off in the morning. Package directions or doctor's instructions should be followed, but one application is normally sufficient to cure an infection.
- Eurax (USP Crotamiton) This is a cure and also helps to relieve itch (pruritis)
- Malathion: Applied for 24 hours; effective in killing both adults and eggs.
- Lindane lotion is approved in the U.S. for use as a second-line treatment where first-line medications like permethrin have either failed, are not well tolerated or otherwise contraindicated. It is illegal in 17 other countries, and 33 more countries have restricted its use. Though rare, serious side effects have resulted from product misuse. The FDA has confirmed 3 deaths that all involved use of lindane not in accordance with the label, including excessive topical applications and oral ingestions.
- There is some evidence that a 10% sulfur ointment in petroleum jelly applied topically is effective. It is cheap and readily available without a prescription. It also has the advantage of being well-tolerated in pregnant women and infants under two months of age.
- Neem oil is deemed very effective in the treatment of scabies although only preliminary scientific proof exists which has yet to be corroborated. It is recommended for those who are sensitive to permethrin, a known insecticide, which might cause irritation. The scabies mite, furthermore, has yet to become resistant to neem, so in persistent cases neem has been shown to be very effective.
- Tea tree oil at 5% was only partially effective and does not seem to be a viable solution for treatment. In one study, it was more effective than commercial medications against the scabies mite in an in vitro situation.
A single dose of Ivermectin has been reported to reduce the load of scabies but another dose is required after 2 weeks for full eradication. In 1999 a small scale test comparing topically applied Lindane to orally administered Ivermectin found no statistically significant differences between the two treatments. As Ivermectin is easily administered (not requiring a rub-down of the whole body like lindane or permethrin twice per treatment), compliance is much higher among self-administering patients. Ivermectin is used in eradication programs of many parasites of both human and animal.
Side effects may include mild abdominal pain, nausea, vomiting, myalgia and/or arthralgia, but they all usually diminish even while treatment is still underway. The product is considered safe for use in children over five years of age.
Public health and prevention strategies
There is no vaccine available for scabies, nor are there any proven causative risk factors. Therefore, most strategies focus on preventing re-infection. All family and close contacts should be treated at the same time, even if asymptomatic. Cleaning of environment should occur simultaneously, as there is a risk of reinfection. Therefore it is recommended to wash and hot iron all material (such as clothes, bedding and towels) that has been in proximity to a scabies infestation.
Cleaning of the environment should include:
- Treatment of furniture and bedding.
- Vacuuming floors, carpets and rugs.
- Disinfecting floor and bathroom surfaces by mopping.
- Cleaning the shower/bath tub after each use.
- Daily washing of recently worn clothes, towels and bedding in hot water and then drying in high heat and/or steam ironing.
Itchiness during treatment
Options to combat itchiness include antihistamines such as chlorpheniramine. Prescription: Hydroxyzine (Atarax).
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