Editing Scabies (section)

== Management ==
===Treatment===
Several medications are effective in treating scabies.  Treatment should involve the entire household and any others who have had recent, prolonged contact with the infested individual.<ref name=Clinic2009 /> In addition to treating the infestation, options to control itchiness include [[antihistamine]]s and prescription anti-inflammatory agents.<ref>{{cite journal | vauthors = Vañó-Galván S, Moreno-Martin P | title = Generalized pruritus after a beach vacation. Diagnosis: scabies | journal = Cleveland Clinic Journal of Medicine | volume = 75 | issue = 7 | pages = 474, 478 | date = July 2008 | pmid = 18646583 | doi = 10.3949/ccjm.75.7.474 | doi-broken-date = 1 November 2024 | s2cid = 72142958 }}</ref> Bedding, clothing and towels used during the previous three days should be washed in hot water and dried in a hot dryer.<ref>{{cite web|title=Parasites - Scabies|url=https://www.cdc.gov/parasites/scabies/treatment.html|website=cdc.gov|access-date=11 December 2014|date=November 2, 2010|url-status=live|archive-url=https://web.archive.org/web/20141211055629/http://www.cdc.gov/parasites/scabies/treatment.html|archive-date=11 December 2014}}</ref>

Treatment protocols for crusted scabies are significantly more intense than for common scabies.<ref name=CDC2010Tx2/><ref>{{cite journal | vauthors = Salavastru CM, Chosidow O, Boffa MJ, Janier M, Tiplica GS | title = European guideline for the management of scabies | journal = Journal of the European Academy of Dermatology and Venereology | volume = 31 | issue = 8 | pages = 1248–1253 | date = August 2017 | pmid = 28639722 | doi = 10.1111/jdv.14351 | s2cid = 32956377 | doi-access = free }}</ref><ref>{{cite web | url=https://dermnetnz.org/topics/crusted-scabies | title=Crusted scabies| vauthors = Thomas L |publisher=DermNet|date=October 2021}}</ref>

=== Permethrin ===
[[Permethrin]], a [[pyrethroid]] insecticide, is the most effective treatment for scabies,<ref name=Cochrane07>{{cite journal | vauthors = Strong M, Johnstone P | title = Interventions for treating scabies | journal = The Cochrane Database of Systematic Reviews | volume = 2007 | issue = 3 | pages = CD000320 | date = July 2007 | pmid = 17636630 | pmc = 6532717 | doi = 10.1002/14651858.CD000320.pub2 | veditors = Strong M }}</ref> and remains the treatment of choice.<ref name="Clinic2009" /><ref name=IDPH/> It is applied from the neck down, usually before sleep, and left on for about 8 to 14 hours, then washed off in the morning.<ref name=Clinic2009 /> Care should be taken to coat the entire skin surface, not just symptomatic areas; any patch of skin left untreated can provide a "safe haven" for one or more mites to survive. One application is normally sufficient, as permethrin kills eggs, hatchlings, and adult mites, though many physicians recommend a second application three to seven days later as a precaution.  Crusted scabies may require multiple applications or supplemental treatment with oral ivermectin (below).<ref name=Clinic2009 /><ref name=IDPH>{{cite web |url=http://www.idph.state.il.us/public/hb/hbscab.htm |title=Scabies |access-date=2010-10-07 |publisher=Illinois Department of Public Health |date=January 2008 |url-status=live |archive-url=https://web.archive.org/web/20101205092146/http://www.idph.state.il.us/public/hb/hbscab.htm |archive-date=2010-12-05 }}</ref><ref name=Pillbook>{{cite book |title=The Pill Book |pages=[https://archive.org/details/pillbook14thedit00haro/page/867 867–69] |isbn=978-0-553-59340-2 |year=2010 |publisher=Bantam Books |url-access=registration |url=https://archive.org/details/pillbook14thedit00haro/page/867 }}</ref> Permethrin may cause slight irritation of the skin that is usually tolerable.<ref name=Ray2009 /> In recent years, concern is growing about permethrin-resistant scabies,<ref>{{cite journal | vauthors = Mounsey KE, Pasay CJ, Arlian LG, Morgan MS, Holt DC, Currie BJ, Walton SF, McCarthy JS | title = Increased transcription of Glutathione S-transferases in acaricide exposed scabies mites | journal = Parasites & Vectors | volume = 3 | pages = 43 | date = May 2010 | pmid = 20482766 | pmc = 2890653 | doi = 10.1186/1756-3305-3-43 | doi-access = free }}</ref><ref>{{cite web | url=https://academic.oup.com/bjd/article/190/4/486/7478651 | doi=10.1093/bjd/ljad501 | title=Comparison of topical permethrin 5% vs. Benzyl benzoate 25% treatment in scabies: A double-blinded randomized controlled trial | date=2024 | journal=British Journal of Dermatology | volume=190 | issue=4 | pages=486–491 | vauthors = Meyersburg D, Hoellwerth M, Brandlmaier M, Handisurya A, Kaiser A, Prodinger C, Bauer JW }}</ref> although some researchers refer to this as pseudo-resistance.<ref>{{cite journal | vauthors = Yürekli A | title = Is there a really resistance to scabies treatment with permethrin? In vitro killing activity of permethrin on Sarcoptes scabiei from patients with resistant scabies | journal = Dermatologic Therapy | volume = 35 | issue = 3 | pages = e15260 | date = March 2022 | pmid = 34897912 | doi = 10.1111/dth.15260 | doi-access = free }}</ref>

=== Ivermectin ===
Oral [[ivermectin]] is effective in eradicating scabies, often in a single dose.<ref name="WHO"/><ref name=Clinic2009 /> It is the treatment of choice for crusted scabies, and is sometimes prescribed in combination with a topical agent.<ref name=Clinic2009 /><ref name=Ray2009 /> It has not been tested on infants, and is not recommended for children under six years of age.<ref name=Ray2009 />

[[Topical]] ivermectin preparations are effective for scabies in adults.<ref>{{cite journal | vauthors = Victoria J, Trujillo R | title = Topical ivermectin: a new successful treatment for scabies | journal = Pediatric Dermatology | volume = 18 | issue = 1 | pages = 63–65 | date = 2001 | pmid = 11207977 | doi = 10.1046/j.1525-1470.2001.018001063.x | s2cid = 39384922 }}</ref> It has also been useful for [[sarcoptic mange]], the veterinary analog of human scabies.<ref>{{cite journal | vauthors = Soll MD, d'Assonville JA, Smith CJ | title = Efficacy of topically applied ivermectin against sarcoptic mange (Sarcoptes scabiei var. bovis) of cattle | journal = Parasitology Research | volume = 78 | issue = 2 | pages = 120–122 | year = 1992 | pmid = 1557323 | doi = 10.1007/BF00931652 | s2cid = 28579947 }}</ref><ref>{{cite journal | vauthors = Carr PC, Brodell RT | title = IMAGES IN CLINICAL MEDICINE. Scabies | journal = The New England Journal of Medicine | volume = 374 | issue = 11 | pages = e13 | date = March 2016 | pmid = 26981951 | doi = 10.1056/NEJMicm1500116 }}</ref>

One review found that the efficacy of permethrin is similar to that of systemic or topical ivermectin.<ref>{{cite journal | vauthors = Rosumeck S, Nast A, Dressler C | title = Ivermectin and permethrin for treating scabies | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 4 | pages = CD012994 | date = April 2018 | pmid = 29608022 | pmc = 6494415 | doi = 10.1002/14651858.CD012994 }}</ref> A separate review found that although oral ivermectin is usually effective for the treatment of scabies, it does have a higher treatment failure rate than topical permethrin.<ref>{{cite journal | vauthors = Dhana A, Yen H, Okhovat JP, Cho E, Keum N, Khumalo NP | title = Ivermectin versus permethrin in the treatment of scabies: A systematic review and meta-analysis of randomized controlled trials | journal = Journal of the American Academy of Dermatology | volume = 78 | issue = 1 | pages = 194–198 | date = January 2018 | pmid = 29241784 | doi = 10.1016/j.jaad.2017.09.006 | doi-access = free }}</ref> Another review found that oral ivermectin provided a reasonable balance between efficacy and safety.<ref name="Thadanipon2019">{{cite journal | vauthors = Thadanipon K, Anothaisintawee T, Rattanasiri S, Thakkinstian A, Attia J | title = Efficacy and safety of antiscabietic agents: A systematic review and network meta-analysis of randomized controlled trials | journal = Journal of the American Academy of Dermatology | volume = 80 | issue = 5 | pages = 1435–1444 | date = May 2019 | pmid = 30654070 | doi = 10.1016/j.jaad.2019.01.004 | doi-access = free }} {{open access}}</ref> A study has demonstrated that scabies is markedly reduced in populations taking ivermectin regularly;<ref>{{cite journal | vauthors = Crump A, Ōmura S | title = Ivermectin, 'wonder drug' from Japan: the human use perspective | journal = Proceedings of the Japan Academy. Series B, Physical and Biological Sciences | volume = 87 | issue = 2 | pages = 13–28 | date = 10 February 2011 | pmid = 21321478 | pmc = 3043740 | doi = 10.2183/pjab.87.13 | bibcode = 2011PJAB...87...13C }}</ref> the drug is widely used for treating scabies and other parasitic diseases, particularly among the poor and disadvantaged in the tropics, beginning with the developer Merck providing the drug at no cost to treat [[onchocerciasis]] from 1987.<ref>{{cite journal | vauthors = Laing R, Gillan V, Devaney E | title = Ivermectin - Old Drug, New Tricks? | journal = Trends in Parasitology | volume = 33 | issue = 6 | pages = 463–472 | date = June 2017 | pmid = 28285851 | pmc = 5446326 | doi = 10.1016/j.pt.2017.02.004 }} {{open access}}</ref>

=== Others ===
Other treatments include [[lindane]], [[benzyl benzoate]], [[crotamiton]], [[malathion]], and [[sulfur]] preparations.<ref name=Clinic2009 /><ref name=Ray2009 /> [[Lindane]] is effective, but concerns over potential neurotoxicity have limited its availability in many countries.<ref name=Ray2009 /> It is banned in [[California]],<ref>{{cite journal | vauthors = Humphreys EH, Janssen S, Heil A, Hiatt P, Solomon G, Miller MD | title = Outcomes of the California ban on pharmaceutical lindane: clinical and ecologic impacts | journal = Environmental Health Perspectives | volume = 116 | issue = 3 | pages = 297–302 | date = March 2008 | pmid = 18335094 | pmc = 2265033 | doi = 10.1289/ehp.10668 | bibcode = 2008EnvHP.116..297H }}</ref> but may be used in other states as a second-line treatment.<ref>{{cite web |url=https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm110845.htm |title=FDA Public Health Advisory: Safety of Topical Lindane Products for the Treatment of Scabies and Lice |publisher=Fda.gov |date=2009-04-30 |access-date=2010-11-14 |url-status=live |archive-url=https://web.archive.org/web/20101126031740/https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm110845.htm |archive-date=2010-11-26 }}</ref> Sulfur ointments or benzyl benzoate are often used in the developing world due to their low cost;<ref name=Ray2009 /> Some 10% sulfur solutions have been shown to be effective,<ref name="pmid20236379">{{cite journal | vauthors = Jin-gang A, Sheng-xiang X, Sheng-bin X, Jun-min W, Song-mei G, Ying-ying D, Jung-hong M, Qing-qiang X, Xiao-peng W | title = Quality of life of patients with scabies | journal = Journal of the European Academy of Dermatology and Venereology | volume = 24 | issue = 10 | pages = 1187–1191 | date = October 2010 | pmid = 20236379 | doi = 10.1111/j.1468-3083.2010.03618.x | s2cid = 21544520 }}</ref> and sulfur ointments are typically used for at least a week, though many people find the odor of sulfur products unpleasant.<ref name=Ray2009 /> Crotamiton has been found to be less effective than permethrin in limited studies.<ref name=Ray2009 /> Crotamiton or sulfur preparations are sometimes recommended instead of permethrin for children, due to concerns over [[Absorption (skin)|dermal absorption]] of permethrin.<ref name=Clinic2009 />

<gallery widths="200" heights="160">
File:ScabiesD04.jpg|Day 4
File:ScabiesD08.JPG|Day 8 (treatment begins)
File:ScabiesD12.JPG|Day 12 (under treatment)
File:ScabiesHealed.JPG|Healed
</gallery>

===Communities===
Scabies is endemic in many developing countries,<ref name="Clinic2009"/> where it tends to be particularly problematic in rural and remote areas. In such settings, community-wide control strategies are required to reduce the rate of disease, as treatment of only individuals is ineffective due to the high rate of reinfection. Large-scale mass drug administration strategies may be required where coordinated interventions aim to treat whole communities in one concerted effort.<ref name="Hay2013">{{cite journal | vauthors = Hay RJ, Steer AC, Chosidow O, Currie BJ | title = Scabies: a suitable case for a global control initiative | journal = Current Opinion in Infectious Diseases | volume = 26 | issue = 2 | pages = 107–109 | date = April 2013 | pmid = 23302759 | doi = 10.1097/QCO.0b013e32835e085b | s2cid = 26416151 }}</ref> Although such strategies have shown to be able to reduce the burden of scabies in these kinds of communities, debate remains about the best strategy to adopt, including the choice of drug.<ref name="Hay2013"/><ref name="Engelman2013">{{cite journal | vauthors = Engelman D, Kiang K, Chosidow O, McCarthy J, Fuller C, Lammie P, Hay R, Steer A | title = Toward the global control of human scabies: introducing the International Alliance for the Control of Scabies | journal = PLOS Neglected Tropical Diseases | volume = 7 | issue = 8 | pages = e2167 | year = 2013 | pmid = 23951369 | pmc = 3738445 | doi = 10.1371/journal.pntd.0002167 | doi-access = free }}</ref>

The resources required to implement such large-scale interventions in a cost-effective and sustainable way are significant. Furthermore, since endemic scabies is largely restricted to poor and remote areas, it is a public health issue that has not attracted much attention from policymakers and international donors.<ref name="Hay2013"/><ref name="Engelman2013"/>