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Top Over-the-Counter Scabies Treatments & Prescription Medications

What Is Scabies?

Scabies, also known as sarcoptic mange, is an itchy, parasitic skin condition caused by the microscopic scabies mites (Sarcoptes scabei) that burrow and live under your skin, where they lay their eggs. Scabies is extremely contagious and spreads through skin-to-skin contact as well as contact with objects handled by an infested individual (e.g. bedding, towels, clothes, and furniture). It is spread most easily in crowded or congested living areas, such as child-care facilities, nursing homes, and dormitories.

Scabies Symptoms

Referred to by some as the "seven-year itch," scabies most notably causes intense itching that can get worse at night. Symptoms may take a few weeks (3-6 weeks) to appear for the first infestation. It may take less time for symptoms to appear—as soon as 1-4 days—in subsequent infestations. You may see rashes with small bumps that resemble pimples or bug bites. Occasionally, you may also raised lines where the mites burrowed.

Overview of Treatments

Scabies treatment is a multistep process that requires thorough treatment of the infested person and their living space—including carpets, rugs, curtains, furniture, bedding, towels, and clothes—and likely the people they live with as well. This will ensure that all the mites are eradicated and prevent future infestations.

Over-the-Counter Scabies Remedies

Over-the-counter scabies treatments are available at drugstores like CVS and Walgreens, but they do not kill the mites. However, they can be used in combination with prescriptions to treat the symptoms, relieving itchiness and redness. Common OTC medications for scabies include:

  1. Nix 1%
  2. Sulfur creams, lotions, and soaps
  3. Hydrocortisone
  4. Calamine lotion
  5. Antihistamines

This article will present currently available prescription and over-the-counter scabies treatments, and discuss their uses, effectiveness, and safety.

Prescription Scabies Medications

For the infested individual, scabicidal medicines (drugs that kill the scabies mites and eggs) are the primary treatment option because they are proven to eradicate the mites. These can be topical (applied on the skin) or oral (ingested). FDA-approved treatments that kill scabies mites and eggs are only available by prescription and include:

  1. Permethrin 5%
  2. Benzyl benzoate 25%
  3. Sulfur ointments 5%-10%
  4. Crotamiton 10%
  5. Lindane lotion 1%
  6. Ivermectin (oral)
The most common locations for scabies include the wrist, genitalia, lower abdomen, armpits, behind the elbows and knees, and in between the fingers and toes.

The most common locations for scabies include the wrist, genitalia, lower abdomen, armpits, behind the elbows and knees, and in between the fingers and toes.

Be Thorough and Consistent

It is important to treat scabies exactly as instructed by your doctor. Failure to do so may result in undertreatment or overtreatment—both of which will lead to unwanted problems.

What Can You Use for Scabies Over the Counter?

Although OTC scabies treatments do not kill the scabies mites and are not FDA-approved for treatment of scabies, they can be very effective for reducing itchiness and redness while waiting for, or in combination with, a prescription. It is recommended to speak with a doctor or pharmacist about which OTC treatment is right for you.

1. Nix (Permethrin 1%)

Nix is a popular treatment for head lice that has been used by some as an OTC remedy for scabies. However, at one-fifth the strength of prescription permethrin, Nix isn't very effective against scabies since it won't kill the mites or the eggs.

2. Sulfur Ointments, Creams, Lotions, and Soaps

Various brands offer over-the-counter treatments containing sulfur compounds in the form of ointments, creams, lotions, and even soaps. Sulfur treatments are commonly used to treat acne because, like benzoyl peroxide or salicylic acid, it helps dry out pimples. Sulfur can be very effective for some people to treat scabies, and is safe for everyone, although it does have an off-putting smell and texture.

3. Steroidal Creams (Hydrocortisone)

Creams like Cortizone 10 are used to reduce itchiness, redness, and other skin irritations. If your scabies is causing you severe itchiness, using a hydrocortisone cream or lotion in conjunction with your prescription medication may reduce your itchiness, preventing you from scratching and damaging your rashes and helping you sleep better at night. However, note that for some people, hydrocortisone may cause or worsen skin irritation. It is common to dilute the cream with a moisturizing lotion (also helps with dryness) if you have sensitive skin.

4. Calamine Lotion

Calamine lotion (a mixture of calamine and zinc oxide or ferric oxide) is generally used to treat mild itchiness or irritation from poison ivy, bug bites, and sunburns. Depending on the severity and stage of your scabies infestation, calamine lotion may not be enough to reduce your itchiness or redness. It is recommended to apply the lotion every 6-8 hours, and it is important not to overdo it. Some people can have an adverse reaction and develop new rashes.

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5. Antihistamines

Taking drowsy (e.g. Benadryl) or non-drowsy (e.g. Claritin or Zyrtec) antihistamines is another effective way to reduce itchiness and help you sleep at night.

Keep Track of Treatments Used

Whether you use natural remedies, OTC medications, or prescriptions, keep a log of the scabies treatments and other medications you may be taking. This can help you and your doctor determine what does and doesn't work for you.

List of Prescription Scabies Treatments

List of scabies treatments that may be prescribed. Note that lindane lotion and ivermectin are only used as a last resort—when all other treatment options have failed.

Drug (Brands)TypeEffectivenessSafety

1. Permethrin Cream 5% (Elimite)



For adults and children 2 months or older. Considered safe for pregnant women, but not for nursing mothers.

2. Benzyl Benzoate Lotion 25%



Recommended to avoid if you have sensitive skin, are pregnant or breastfeeding, or are elderly. Children can use at reduced strengths (10% or 12.5%).

3. Sulfur Ointment 5%-10% (various brands)



Considered safe for everyone, including children 2 months and older.

4. Crotamiton Cream or Lotion 5%-10% (Eurax, Crotan)



Not FDA-approved for children.

5. Lindane Lotion 1%



Possible side effects include seizures, and brain and nerve damage. Should not be used by children, elderly, pregnant/nursing women, people under 110 lbs, or people with seizure disorders.

6. Ivermectin (Stromectol)



Should not be used by pregnant/nursing women or children under 33 lbs (15 kg). Not FDA-approved specifically for scabies treatment.

Permethrin is a topical, scabicidal agent prescribed for the treatment of scabies.

Permethrin is a topical, scabicidal agent prescribed for the treatment of scabies.

1. Permethrin 5% (Elimite)

Permethrin is used widely as an insecticide and insect repellent. As a cream, permethrin is used to treat mites like, lice and scabies. It is available OTC at a strength of 1% (Nix), and as a prescription at a strength of 5% (Elimite).

Prescription-strength permethrin is considered the treatment of choice by doctors because of its proven efficacy and safety. Results can usually be seen in about a week—less time than crotamiton and sulfur ointments—and it can be used for children as young as 2 months, and for pregnant women. Nursing mothers are recommended to avoid using permethrin due to the possibility of the child ingesting the drug.

Side Effects

If used as instructed, possible side effects are limited to a slight burning or stinging sensation, itchiness, and development of a rash where the cream was applied. More severe side effects are rare but include numbness and tingling, headaches, dizziness, nausea, abdominal pain, and seizures.

How Do I Use It?

Moderate cases usually only require one application. Again, you should follow your doctor's specific instructions, but here are some general guidelines:

  1. Thoroughly clean and dry your body.
  2. Apply a thin layer covering your whole body from the neck down. Make sure you don't miss creases, folds, and areas between your fingers and toes.
  3. Apply under the fingernails as well. A toothbrush or cotton swab may help with this.
  4. Wash off with warm, soapy water after about 12 hours.

If necessary, your doctor may recommend that you apply this cream two or more times, with a week between each application.

What if I Miss a Dose?

Apply it as soon as you realize you missed a dose. You don't need to double the dose or apply a thicker layer and should actually avoid doing so to minimize adverse side effects.

2. Benzyl Benzoate 25%

Benzyl benzoate 25% is considered a cost-effective alternative to permethrin cream. It may be formulated with or without tea tree oil, a natural antiseptic. Like permethrin 5%, benzyl benzoate 25% can also be used by pregnant women and children 2 months and older. For children, a lower strength (10% or 12.5%) should be used to minimize the side effects.

Side Effects

As for permethrin, side effects include a burning or itching sensation. Although rare, overdosing can result in jerking movements, difficulty urinating, fainting, and formation of blisters, crusts, and scales. You should seek medical attention immediately if you notice any symptoms of an overdose.

How Do I Use It?

Generally, one dose is enough, although more may be recommended by your doctor depending on the severity of your infestation.

  1. Clean and dry your body.
  2. Cover your entire body with the medication and leave on for 24 hours.
  3. Wash off with warm, soapy water.

3. Sulfur Ointments 5%-10%

Sulfur ointments are also used to kill scabies mites but aren't as effective as permethrin 5% or benzyl benzoate 25%. However, they are considered safe for everyone to use. They are generally used in conjunction with other scabies treatments rather than on their own.