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Scabies – How to treat

Permethrin Application instructions

o Scabies can spread easily through skin-to-skin contact with other people. Contacts will likely include all household members and sexual partners. It could also include any other skin contacts such as members of sports teams and individuals who do not live in an affected household but provide care, e.g. visiting family members, child minders and adult day care providers.

o Not all individuals with scabies have itch and rash. Asymptomatic people will re-infest their contacts if they are not treated concurrently.

o It is important that Permethrin is applied correctly to ensure successful eradication of the scabies mites.

o All people need two treatments one week apart.

o Treatment is best applied at night

o Remove all clothes

o Wash before treatment with cool (not hot) shower ensuring skin creases and areas under nails are cleaned thoroughly. Would advise cutting nails short.

o Apply to clean, cool, dry skin.

o Apply to all of skin including all of body, neck, scalp and face (only avoiding areas around eyes). The product advice may suggest not treating scalp and face but in fact would advise all these areas are treated to manage infestation.

o Certain areas of skin need particular attention for treatment to be successful.

Ensure product is applied generously to:

o areas between fingers and toes

o genital areas

o areas behind ears

o nipples

o under nails. Use nail brush to clean out nails before hand and cut short if possible (use of a soft toothbrush can help with Permethrin application).

o Ideally remove all jewellery. If this is not possible make sure to apply under any jewellery

o Apply product to soles of feet last

o Once applied leave 10-15 minutes for product to dry before putting any clothes on.

o Treatment should be left on skin for at least 12 hours.

o If any areas are washed during this time (especially hands) product should be reapplied after each hand wash.

o The product should be washed off without soap initially. Once completely showered soap and/ or moisturisers or emollients can be used.

o Once treatment has been used you can return to all normal activities.

o Treatments should be repeated as above one week later to ensure effective eradication of both the scabies mite and the scabies eggs.

o Sheets, towels and clothes should be washed at 60 degrees. Any delicates or clothes that cannot be washed should be bagged for 72 hours.

o Itching may last for up to 6 weeks even if treatment has been successful to eliminate infestation of scabies.

o Treatments can cause irritation of this skin which can be one cause of ongoing rash and itch. Moisturisers (emollients), treatment of dermatitis/ eczema such as topical corticosteroids and anti-histamine tablets may be used if needed.

o Eurax can be used 2 -3 times daily to help with post treatment itch.

o If skin problems do not settle following 6 weeks after treatment or any ongoing concerns, then a review of skin by a health worker should be arranged.

Adapted from CKS Permethin cream NICE 2024 and BSPAD Scabies 2024