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Scabies

NICE CKS Scabies. Last revised: May 2025.

Guidelines

Usually clinical diagnosis.

If equipment and expertise allows, tests can be done to provide a definitive diagnosis:
  • Ink burrow test (black or blue ink applied to the lesion and wiped off to remove surface ink)
    • +ve Finding: dark zigazgged line running across and away from the lesion (due to ink tracking down the mite burrow)
  • Skin scrapings microscopy
    • Presence of mites / eggs / mite faecal material confirms the diagnosis

Seek specialist advice if:

  • <2 months (rare in this age group and permethrin cream is only licensed for ≥2 months)
  • Crusted scabies (hospital admission may be required and investigation for underlying immunodeficiency)
 

Advise that bedding, clothing, and towels (and those of all potentially infested contacts) should be decontaminated by washing at a high temperature (at least 60°C) and drying in a hot dryer, or dry-cleaning, or by sealing in a plastic bag for at least 72 hours

Offer:
  • Permethrin 5% cream, or
  • Single dose oral ivermectin 200 mcg/kg


Both has similar effectiveness, choose based on the following patient factors
  • Avoid permethrin if
    • <2 y/o (unlicensed in <2 months)
    • Pre-existing eczema or other skin conditions which may lead to hypersensitivity
 
  • Avoid ivermectin if
    • Pregnant and breastfeeding
    • Severe hepatic impairment
    • <15 kg
 

Advise that itching may continue for up to 4 weeks after successful treatment of scabies. Patients should seek medical advice if itching persists >2-4 weeks after last treatment application.

All the following should be treated with anti-scabies treatment, even if asymptomatic:
  • Household members
  • Sexual partners within past month
  • Any other close personal contacts

  • Crotamiton 10% cream
  • If scabies mites have definitely been eradicated: topical hydrocortisone 1%

Also consider night time sedating antihistamine (e.g. chlorphenamine) to improve sleep and reduce scratching

References

Author: Adams Lau
Reviewer:
Last edited: 15/07/25