Usual first treatment

• Apply at night to clean, dry skin from the neck down, including between fingers/toes, under nails, groin, buttocks, and soles.
• Leave on 8-14 hours, then wash off.
• Many clinicians advise repeating after 7 days, especially if symptoms or active lesions continue.
• For babies and young children, the scalp, face, and neck may also need treatment, but get child-specific instructions first. CDC clinical guidance has age-specific details.

Other prescription option

Treat contacts and laundry at the same time

• Treat everyone in the household and sexual or close skin-contact partners at the same time, even if they do not itch yet.
• Wash clothes, towels, and bedding used during the previous 3 days in hot water and dry on high heat.
• Items that cannot be washed can be sealed in a bag for several days to a week.
• Mites usually survive only 2-3 days away from skin. CDC prevention advice

Itching after treatment

Seek medical care promptly if

• Thick crusting or widespread scaling, especially in an older or immunocompromised person
• Pus, painful skin, fever, or spreading redness, which can indicate bacterial infection
• You are pregnant, breastfeeding, treating an infant, or have a child under 2 months
• Symptoms persist after correctly treating both you and contacts

1. UKHSA: management of scabies in care homes and other closed settings, updated April 2026
   Best current public-health guidance for outbreaks in long-term care, prisons, boarding schools, hostels, and similar settings. It recommends coordinated treatment of cases and contacts, two treatment doses one week apart, environmental measures, and specialist-guided combination therapy for crusted scabies. See the UKHSA 2026 outbreak guidance.
2. HSE Ireland Scabies Treatment Guideline, version 2.3, reviewed February 2025 and uploaded February 2026
   A practical all-age clinical protocol. It emphasizes simultaneous household treatment, correct full-body topical application, repeating treatment, management of persistent itch, and specialist input for infants under 2 months, immunocompromised patients, outbreaks, crusted scabies, and suspected resistance. Read the HSE treatment guideline.
3. BASHH National Guideline on Management of Scabies in Adults, 2025
   The latest peer-reviewed national adult guideline, particularly relevant to sexual-health services and sexual contacts. It covers diagnosis, treatment, contact management, and follow-up for adults and people aged 13 years or older. Morris et al. (2025), International Journal of STD & AIDS, PMID 40103364.
4. CDC Clinical Care of Scabies, United States, current online guidance
   Useful for US prescribing and available medications. It lists permethrin 5% cream and oral ivermectin as first-line options for classic scabies, while crusted scabies requires both topical and oral therapy. See CDC clinical care guidance. For household control, laundry, return to school/work, and the fact that itch can persist after eradication, see CDC patient and prevention guidance.
5. International Journal of Dermatology Clinical Practice Guidelines, 2024
   A broad international clinical guideline for diagnosis and treatment: Uzun et al., “Clinical practice guidelines for the diagnosis and treatment of scabies,” International Journal of Dermatology 2024;63:1642-1656, DOI: 10.1111/ijd.17327. It is a useful global clinical reference where national recommendations are unavailable.

• Treat the diagnosed person and close household or sexual contacts at the same time.
• Correct topical application and repeating treatment at the recommended interval are central to success.
• Persistent itch alone for several weeks does not necessarily mean treatment failed.
• New burrows or new typical lesions suggest possible reinfestation, incorrect use, untreated contacts, or an alternative diagnosis.
• Suspected crusted scabies, treatment failure, pregnancy, very young infants, immunosuppression, and institutional outbreaks need clinician or specialist input.

• Scabies was never fully cleared because close contacts were not treated at the same time or treatment was not applied correctly.
• Re-infestation from an untreated household or sexual contact.
• Crusted scabies, especially if there are thick, scaly, crusted areas or if you have reduced immunity.
• Itching or eczema after scabies treatment, which can persist, but usually for weeks rather than a year.
• A different condition that looks like scabies, such as eczema, allergic/contact dermatitis, fungal infection, bedbugs/fleas, psoriasis, or another skin disease.

1. Confirmation that it is truly scabies.
2. Review of every treatment you have already used, including how and when it was applied.
3. Examination and treatment of all close contacts if scabies is confirmed.
4. Assessment for bacterial infection or crusted scabies.
5. A plan for itch/eczema after mites are cleared.

Bring or write down

1. Timeline
   • When the itching/rash first started
   • Where it began and where it spread
   • Whether itching is worse at night
   • Dates when it became better or worse
2. Photos
   • Take clear photos in good light of all affected areas today.
   • Bring older photos showing the rash at its worst or before treatment.
   • Include hands, finger webs, wrists, waist, genitals, buttocks, feet, and any thick or crusted skin.
3. Every treatment you have used Write the name, strength, dates, and result for:
   • Permethrin cream or lotion
   • Ivermectin tablets
   • Steroid creams or tablets
   • Antihistamine tablets
   • Antibiotics, antifungal creams, herbal or over-the-counter products
   Also explain exactly how you used scabies creams: which body areas, how long left on, whether you repeated it, and whether you reapplied it after washing hands.
4. Close-contact information
   • Does anyone at home have itching or a rash?
   • Were all household members and sexual contacts treated at the same time?
   • Did symptoms return after close contact with any untreated person?
   • Any exposure in shared accommodation, care setting, school, hostel, or workplace?
5. Medical information
   • List of all regular medicines and allergies
   • Pregnancy or breastfeeding, if applicable
   • Diabetes, HIV, cancer treatment, steroid or immune-suppressing medication, kidney/liver disease
   • Prior skin problems such as eczema, psoriasis, allergy, or fungal infection

Before the appointment

• Do not apply a new scabies medicine or strong steroid cream immediately before the visit unless a clinician has instructed you to. It can alter the appearance of the rash.
• Do not scrub or pick at suspected burrows.
• Wear loose clothing so the doctor can examine the areas easily.
• Ask whether they can perform dermoscopy or a skin scraping to look for mites, eggs, or mite droppings. These can help confirm scabies, although a negative scraping does not always rule it out. The CDC describes these diagnostic methods.

Questions to ask the dermatologist

• “Can you confirm whether this is active scabies or another skin disease?”
• “Could this be eczema or an allergic reaction from repeated creams?”
• “Do I need a skin scraping, dermoscopy, fungal test, bacterial swab, or biopsy?”
• “If it is scabies, do my contacts need treatment again?”
• “Could this be crusted scabies or treatment-resistant scabies?”
• “What should I use safely for itch and skin inflammation while we determine the cause?”

Seek urgent care before the appointment if