This handout is for scabies — classic & crusted (norwegian). Your care team identified this based on: intense, generalised, nocturnally-worse pruritus (delayed type-iv hypersensitivity to the mite — onset ~3-6 wk in primary infestation, days on re-infestation) (2020 iacs criteria pmid 32034956; european guideline pmid 28639722).
Other reasons your team may use this plan: burrows + papules in finger web-spaces / flexor wrists / axillae / periumbilical / genital (penile/scrotal nodules) / areolae — classic scabies distribution (2020 iacs criteria pmid 32034956); itchy household / sexual / close contacts or an institutional cluster — the single strongest contextual pointer (european guideline pmid 28639722; who control pmid 31178154); hyperkeratotic, crusted, scaly plaques (± reduced/absent itch) in an immunocompromised / hiv / htlv-1 / elderly / institutionalised / neurologic host → crusted (norwegian) scabies (european guideline pmid 28639722; hasan plos ntd 2020 pmid 33338053).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| permethrin | 5% cream, whole body (neck-down; include scalp/face in infants/elderly/crusted) | topical | overnight 8-14 h then wash off; REPEAT on day 7-14 | European guideline (PMID 28639722) + 2020 IACS (PMID 32034956) first-line topical; Cochrane 2018 (PMID 29608022) ~65-74% wk1-2 clearance, 1-3 applications ~93%; the mandatory day-7-14 repeat covers eggs surviving the first dose. |
| treat_all_close_household_sexual_contacts_simultaneously | — | — | — | European guideline (PMID 28639722) — ALL close/household/sexual contacts treated at the same time (even if asymptomatic), 2-month partner look-back; untreated contacts are the dominant re-infestation driver (2024 failure meta-analysis PMID 37625798). |
| environmental_decontamination_hotwash_seal_bag | — | — | — | European guideline (PMID 28639722) — hot-wash (≥50 °C) + hot tumble-dry, or seal in a plastic bag ≥72 h, all clothing/bedding/towels used in the prior 3-4 days; the off-host mite survives only ~24-36 h, days longer in crusted disease. |
Plan: Scabies — stepwise scabicide ladder + contact & environmental control (2020 IACS / European 2017 / WHO NTD)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Confirm eradication at ~4 wk; ensure ALL contacts were treated (untreated contacts = the dominant recurrence driver); reinforce environmental decontamination; in endemic/institutional settings arrange surveillance, MDA linkage, and post-streptococcal-sequelae follow-up after secondary impetigo (urinalysis/BP for post-strep GN). Crusted scabies: relapse is common on return to an endemic community — plan repeat-screening and a low threshold to re-treat the index + cohort.
Guideline: 2020 IACS Consensus Criteria for the Diagnosis of Scabies (Engelman et al, Br J Dermatol; PMID 32034956) + European guideline for the management of scabies (Salavastru et al, JEADV 2017; PMID 28639722) + WHO public-health control of scabies (Engelman et al, Lancet 2019; PMID 31178154) + WHO framework for scabies control (Engelman et al, PLoS NTD 2021; PMID 34473725) + Cochrane ivermectin/permethrin for scabies (Rosumeck et al, 2018; PMID 29608022) + Failure of scabies treatment systematic review/meta-analysis (Mbuagbaw et al, Br J Dermatol 2024; PMID 37625798) + Crusted scabies prospective cohort (Hasan et al, PLoS NTD 2020; PMID 33338053) + MDA for scabies control RCT (Romani et al, NEJM 2015; PMID 26650152)