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.
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:
- Nix 1%
- Sulfur creams, lotions, and soaps
- Calamine lotion
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:
- Permethrin 5%
- Benzyl benzoate 25%
- Sulfur ointments 5%-10%
- Crotamiton 10%
- Lindane lotion 1%
- Ivermectin (oral)
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.
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
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.
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.
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:
- Thoroughly clean and dry your body.
- 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.
- Apply under the fingernails as well. A toothbrush or cotton swab may help with this.
- 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.
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.
- Clean and dry your body.
- Cover your entire body with the medication and leave on for 24 hours.
- 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.
There is no evidence of significant side effects, but as an astringent, it may cause excess dryness and itchiness during initial applications. It is not a very popular treatment option because he odor and texture can be off-putting.
Sulfur ointments are applied similarly to other scabies medications. Cover the entire body and leave on for 8-12 hours before washing off.
4. Crotamiton 10% (Eurax or Crotan)
Crotamiton 10% is another scabicidal prescription that is available as either a lotion or a cream. Unlike permethrin and benzyl benzoate, crotamiton is antipruritic—that is, it also relieves itchiness due to scabies. Although it is approved by the FDA for treating scabies, it is not as effective as permethrin 5%, and frequent failures to treat scabies have been reported. It may be used on children and pregnant mothers only when clearly necessary.
Serious side effects are rare but include skin irritations (rashes, itching, and redness), dizziness, and trouble breathing.
How Do I Use It?
You should follow your doctor's specific instructions, although the general steps are similar to other topical scabies medications.
- Wash and dry your body thoroughly.
- Apply a thin layer all over your body, from the neck down.
- Leave on for 24 hours.
- Apply a second layer.
- Wash off with warm, soapy water 24 hours after the second application.
5. Lindane Lotion 1%
Lindane is a chemical variant that has been used both as an agricultural insecticide and as a pharmaceutical treatment for lice and scabies. It kills both the mites and their eggs. Because lindane is toxic to the nervous system, it is used only as a last resort, when other treatments have failed or caused adverse side effects.
Children, pregnant or nursing mothers, individuals weighing less than 110 lbs, individuals with cuts or other skin breaks, and the elderly should avoid using lindane lotion unless advised by a doctor. If you are prescribed with lindane, you should strictly follow your doctor's instructions for use.
An allergic reaction to lindane may cause rashes, hives, blisters, peeling skin, and difficulty breathing, swallowing, and talking. More severe reactions can result if the drug reaches the bloodstream. This may result in dizziness, uncontrollable body tremors, seizures, and in extreme cases, nerve or brain damage.
How Do I Use It?
Again, you should follow your doctor's instructions, but these are the general guidelines for using lindane lotion:
- Thoroughly wash and dry your body. It is important that your body is completely dry since moisture can increase the possibility that the drug gets absorbed through the skin into the bloodstream.
- Apply a thin layer over the body from the neck down.
- Wash with warm, soapy water after 8-12 hours.
6. Ivermectin (Stromectol)
Ivermectin is an oral, anti-parasitic drug that can be very effective for treating scabies, although it is not FDA-approved for this specific use. Like lindane lotion, ivermectin is generally prescribed only when more popular treatments like permethrin 5%, benzyl benzoate 25%, or crotamiton 10% have failed or caused adverse side effects.
Ivermectin is not recommended for children weighing less than 33 lbs (15 kg) and pregnant or nursing women.
The most common side effects are increased skin irritation, headaches, muscle aches, dizziness, nausea, and diarrhea. An allergic reaction to ivermectin may result in blisters, hives, difficulty breathing, puffy eyes, blurry vision, swelling of the face, and an increased heart rate. If you notice any of these symptoms, seek emergency medical attention immediately.
How Do I Take Ivermectin?
The usual instructions say to take two doses at 200ug/kg/dose, each one week apart. Two doses may be enough, although your doctor may suggest additional doses depending on the severity of your infestation.
Although the instructions that come with the drug usually say to take the drug on an empty stomach, some doctors may recommend taking with a meal to increase bioavailability.
Treatment for Crusted Scabies
Crusted scabies, or Norwegian scabies, is a more severe form of infestation that results in thick crusts and scales. Crusted scabies is more common in those that have a weakened immune system, including:
- Individuals with HIV/AIDS, systemic lupus, or other diseases
- Individuals taking immunosuppresants
- Disabled or debilitated
The hard crusts make it harder for topical treatments to reach and eradicate the mites. Treating crusted scabies requires a slightly different approach to regular scabies. Before application of creams or lotions like permethrin 5%, crusts may need to be reduced either manually (i.e. brushing or light filing) or with a keratolytic cream to thin the scales and promote shedding. This allows the scabies medication to better reach the mites underneath.
More frequent application of creams or lotions may also be necessary. Patients may be instructed to apply the treatment daily for the first week, and then twice a week until all mites are eradicated.
Ivermectin may also be prescribed in combination with permethrin 5% to more effectively treat severe cases of crusted scabies.
Is It Normal for Scabies Symptoms to Get Worse After Treatment?
Your symptoms may get worse before they get better. Prescription drugs used to treat scabies often dry out the skin and can result in increased itching or additional rashes to break out—especially within the first week after the initial treatment. This may be more apparent in individuals with sensitive skin. However, these are common side effects of the treatments that you shouldn't worry about. Symptoms should begin to reduce about two weeks after treatment.
If symptoms do not get any better after a couple of weeks, or if symptoms get worse, call your doctor immediately. It is likely that the treatment is not working for you, or you are allergic to the treatment.
Why Am I Still Itching After Scabies Treatment?
There are three possible reasons why you still feel itchy after your treatment.
1. Prescriptions kill the mites but don't treat the symptoms.
Prescription scabies medication may effectively kill all the mites and eggs, but they do not treat the symptoms, and itching may continue for as long as a few weeks after treatment. This is because the dead mites and eggs, as well as their waste products, are still present.
If you are still itching, there are many OTC medications like the ones discussed above that can stop the itching and reduce redness or swelling. Talk to your doctor or pharmacist about which ones will work best for you.
2. You didn't follow the treatment instructions completely.
Strictly adhere to your doctor's instructions. Make sure you get completely cover the body with the medication. Areas that are commonly missed include certain portions of the back, behind the knees, under skin folds and crevices, and under fingernails and toenails.
Keep the medication on for the prescribed amount of time to ensure all mites and eggs are killed.
Remember that you need to treat your clothes, general living area, and those living with you as well. The treatment may have rid you of scabies, but you may be reinfested if you don't kill all the mites in your house and on the people you have regular close contact with.
3. The medication you are using may not work for you.
Each person is different, and no medication is guaranteed to work for everyone. If, after a few weeks, your symptoms do not get better, talk to your doctor about other possible medications. Lindane lotion and ivermectin are usually prescribed for individuals who don't respond to typical medications like permethrin or crotamiton.
Are You Still Contagious After Scabies Treatment?
When used properly, scabicidal treatments will kill all mites and eggs within 24-48 hours. After this period, individuals are generally not considered contagious. However, mites may still be living on your clothes, furniture, and other object. As mentioned at the beginning of the article, scabies treatment is a multi-step process. As you treat yourself, you should also be treating your clothes, bedding, towels, and living space—as well as those who are living with you.
Can Scabies Go Away on Its Own?
Scabies cannot go away on its own. Some people wonder what will happen if scabies isn't treated. Scabies mites will continue to burrowing and reproducing, causing more rashes and more itchiness until they are killed. It is recommended to treat yourself and everything you touch in order to kill all mites and prevent future infestations.
Home Remedies and Further Tips
While home remedies will not cure an infestation, they can prevent infestations and heal lesions.
- Neem and turmeric: Rinse the skin with a paste made half from new or dry neem leaves and half from turmeric powder mixed with mustard oil. Apply the paste on your body and leave it for no less than an hour before rinsing. Repeat for 7 to 10 days until all scratches have healed.
- Apricot leaves: Likewise, scabies symptoms can be alleviated by using the juice of new apricot leaves, which will soothe the skin and prevent infestation.
- OTC natural or homeopathic remedies: There are many alternative remedies for scabies available at drug stores and natural health stores that may or may not be effective for killing the mites.
- Shower before treatment: Make sure to wash thoroughly before starting treatment so you can apply the medication to clean, dry, skin.
- Wash your sheets: Mites can survive away from human skin for up to a few days. Wash your sheets and clothing in hot water (at least 50 °C or 122 °F for 10 minutes or more) and dry them on hot to kill any mites. If you don't have access to a washer and dryer, take them to a dry cleaner or keep them in a plastic bag for a week.
- Clean your house: Vacuum your floors to get rid of mites.
- Avoid contact with others: Avoid sexual contact or prolonged physical contact of any kind until you are symptom-free.
- Treat your whole household: Finally, make sure that everyone in your household gets treated at the same time so that the mites do not survive by transferring from one person to another.
Though some people believe that scabies is an indicator of bad hygiene, this is not the case. It is much more commonly indicative of crowded living conditions where it can easily spread. If you suspect you have scabies, make sure to go to a doctor and get treatment for you and your household as soon as possible and make sure to inform your sexual partners.
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Mila-Kierzenkowska, C, et al. (2017). Comparative Efficacy of Topical Pertmehrin, Crotamiton and Sulfur Ointment in Treatment of Scabies. Journal of Arthropod-Borne Diseases 11(1): 1-9.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Bethany on March 21, 2017:
They are deep and marveled in my skin, especially my ha B-) day, and under my nails!!!! I've been fighting this for YEARS!!!!
ARainey on November 03, 2015:
Another well-written article on scabies!
mahendra kumar katariya on March 10, 2015:
A good information and precautions
Or journal treatments.
MidnightSunshiine on May 18, 2014:
The idea of bugs living under the skin is frightening. I suppose it is good that the little rascals are microscopic.
Interesting hub and informative.