Scabies Treatment | Five Treatments for Scabies

There are a number of effective scabies treatment options that are currently available in the marketplace. Typically, permethrin is considered to be the most effective of these treatments, though there are alternative treatments available that may preferable to some patients. Here, the five most common scabies treatment options will be discussed. Application instructions will also be provided, along with  information regarding scabies diagnoses and scabies symptoms.

Scabies Symptoms And Information

( Skip ahead to the section labeled “treatment for scabies” if you’re already familiar with the affliction).

The two primary symptoms that are indicative of a scabies infestation are itching and a rash (or, usually, multiple rashes). Patients should be aware of these scabies symptoms.

Areas of the body that the scabies mites are particularly drawn to include the hands, chest, back, genitals, buttocks, and armpits. The mites are also drawn to crevices on the body, such as the crevices between the fingers, and the crevices between the upper and lower arms.

Scabies Treatment pic

This picture illustrates the areas of the body most commonly affected by an outbreak of scabies. Source: CDC

Diagnosing Scabies

Before a round of scabies treatment is prescribed, it’s important that scabies is definitively diagnosed by a doctor. Typically, doctors will examine a patient’s skin scrapings (which aren’t painful to obtain, surprisingly) via microscope to diagnose the disease. However, in cases where a patient is clearly suffering from scabies, the doctor may forgo a microscopic evaluation and begin treatment immediately.

Unfortunately, scabies can be difficult to diagnose and may be confused with a number of other skin afflictions. Scabies has been misdiagnosed as eczema, dermatitis, and syphilis in the developed world. In developing countries, scabies has been mistaken for pyoderma. Additionally, crusted scabies (or Norwegian

Scabies, which is a very severe form of scabies) has been known to be misdiagnosed as psoriasis.

Treatment for Scabies

Once a definitive diagnosis of scabies has been made, then a course of treatment is in order. There are some natural scabies treatments available as well, which are often quite effective, though the efficacy of these natural remedies for scabies has not yet fully been determined. The most common, traditional treatments for scabies include:

1. Permethrin

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Mites often leave a distinctive burrowing trail on the skin of their host, as is seen here. Source: Michael Geary.

As was said earlier, permethrin (5%) is widely considered to be the most effective treatment for scabies. It is only available with a prescription. There are some 1% permethrin solutions available over-the-counter, but these solutions will not treat scabies.

Throughout the majority of the industrialized world, permetrhin is the first-line of treatment for scabies.

Permethrin is a pesticide, which may be unappealing to some patients. It is also cited as a weak carcinogen (cancer-causing material). Still, it is generally asserted that permethrin is perfectly safe in small doses.

Related: Permethrin – Behind the Controversy.

Applying Permethrin

Permethrin is applied topically, from the neck down on adults.  Patients should remove any jewelry they’re wearing before applying permetrhin. Additionally, fingernails and toenails should be cut as short as possible, and the scabicide should then be applied as far under the nails as far as is possible.

Permethrin must be left on overnight (8-14 hours). If a patient washes their hands at some point during the night, then the cream should be reapplied. In mild cases of scabies, one round of treatment with permethrin will likely be sufficient. In moderate to severe cases, a second round of treatment may be necessary a week or two after the initial treatment.

Permethrin has relatively low toxicity levels, and it is generally well tolerated by most patients. However, permethrin is often not a treatment option for people living in the developing world because of its relatively high cost.

2. Ivermectin

Ivermectin is available in oral and topical forms. Oral Ivermectin is more commonly prescribed, and it is typically considered to be the most effective way of treating individuals with crusted scabies. Oral Ivermectin may also be used in conjunction with a topical solution, such as permethrin — this is often an effective treatment combination.

Ivermectin is considered safe to use, and it has proven to be a viable approach to scabies treatment, particularly in developing countries. Two to

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Ivermectin is sometimes used to treat severe outbreaks of scabies; it is also used in cases of crusted scabies, which can be observed in this patient. Source: Public Domain

five doses Oral Ivermectin (200 mg) are typically prescribed for patients with crusted scabies.

Related: Crusted Scabies Treatment

3. Benzyl Benzonate

One of the most common scabies treatments in developing countries is benzyl benzoate (25%), which is considered to be an effective treatment option. However, it is known to cause significant skin irritation.

Additionally, benzyl benzoate requires two applications per day for 2-3 days, and then another application after 10 days. Because benzyl benzoate causes skin irritation, and requires multiple applications, patient compliance rates may be reduced.

4. Lindane

Lindane was used for many years, all around the world, and it is an effective scabies treatment. However, it is quite toxic, and has been known to cause a number of adverse effects, such as: skin numbness, anxiety, tremors, and restlessness. If ingested, lindane can be fatal. It is typically contraindicated for pregnant or nursing women, infants, and young children.

Patients who take lindane must avoid applying the solution to broken skin. Additionally, they must vigilantly adhere to manufacturer and doctor recommendations. Lindane is usually left on for 6-8 hours and typically requires a second treatment a week after the initial treatment.

5. Sulfur

Sulfur products are one of the best over the counter scabies treatments available. Moreover, it is one of the only natural remedies for scabies that is actually prescribed by physicians.

There haven’t been a large number of studies conducted with regard to the efficacy of sulfur products, but preliminary research seems to indicate that they can treat the disease effectively. Moreover, these treatments have become quite popular among patients seeking a safe, natural, and effective alternative to permethrin.

Sulfur products are generally applied three times on three consecutive days (every 24 hours). Patients are often advised to take a shower or bath before each application of this scabies treatment. Sulfur solutions are perhaps most commonly prescribed to treat pregnant women and infants.

Related: Scabies and Pregnancy, Scabies in Children.

One of the more popular otc sulfur products is the Naturasil Scabies Treatment Starter Pack, which contains a variety of sulfur products (soaps, creams, etc).


Ultimately, there are many scabies treatment options available. By and large, permethrin is still considered to be the most effective option, but the fact that it’s a pesticide may be unappealing to some people. Moreover, there are certainly effective alternatives available, such as sulfur.

Next —-> Scabies Itch Relief — Effective OTC Itch Relievers for Scabies

Other Related Articles: Natural Scabies Treatments – Sulfur, Tea Tree Oil, Neem Oil, and Others, Permethrin – Behind the Controversy, After an Infestation – How to Disinfect the Household, Scabies Causes, Over the Counter Scabies Treatments.

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