Scabies
If initial treatment course is unsuccessful despite correct application and compliance, then refer to local board guidelines, see prescribing notes for links, or contact dermatology for advice.
Apply once weekly for 2 doses, apply 5% preparation over whole body including face, neck, scalp and ears then wash off after 8-12 hours. If hands are washed with soap within 8 hours of application, they should be treated again with cream.
In pregnancy or permethrin allergy
Apply once weekly for 2 doses, apply preparation over whole body, and wash off after 24 hours, if hands are washed with soap within 24 hours, they should be retreated.
Ivermectin with topical treatment may be considered for Crusted or 'Norwegian' scabies, that is unresponsive to topical treatment alone. Or scabies that does not respond to higher frequency extended duration topical treatment.
200 micrograms/kg for 1 dose, further doses of 200 micrograms/kg may be required.
Prescribing Notes:
- Seek specialist advice from dermatology if diagnostic uncertainty or repeated treatment failure.
- All members of the household and close contacts must be treated simultaneously. For more information on contact management refer to Health Protection>Scabies.
- Aqueous preparations are preferable to alcoholic lotions.
- Clothes and bedlinen should be washed at 50 degrees Celsius or above at time of treatment.
- Post scabies itch can persist for up to 2 months after eradication of the mites. It may be relieved by topical crotamiton, or topical menthol (see pruritis recommendations) an oral antihistamine and a moderately-potent topical steroid (see Eczema recommendations).
- For guidance on correct application to British Association of Dermatologist Patient Information Leaflet for Scabies
- For further patient information refer to NHS Inform Scabies.
- Refer to local board guidance for scabies management. In NHS Lothian, see staff intranet resources Health Protection>Scabies. In NHS Fife, refer to Scabies guidance for GPs and community pharmacies [password protected].
History Notes
02/07/2024
Addition of ivermectin tablets ERFC March 2024, prescribing information updated, ERFC May 24.
02/02/2024
Added link to MSAN due to shortages with Permethrin 5% cream.
15/12/2021
East Region Formulary content agreed.
If initial treatment course is unsuccessful despite correct application and compliance, then refer to local board guidance, see prescribing notes for links, or contact dermatology for advice.
For dose, refer to BNF for Children.
In pregnancy or permethrin allergy.
For dose, refer to BNF for Children.
Ivermectin may be considered for Crusted or ‘Norwegian’ scabies, that is unresponsive to topical treatment alone. Or scabies that does not respond to higher frequency extended duration topical treatment.
For dose, refer to product literature.
Prescribing Notes:
- Seek specialist advice from dermatology if diagnostic uncertainty or repeated treatment failure or for treatment of children < 15kg.
- To view product literature external links to the eMC (SPC & patient leaflets) are found next to the medicines choices above or access the eMC website and search for the drug.
- All members of the household and close contacts must be treated simultaneously.
- Treat the whole body from ear/chin downwards, face avoiding lips and eyes, paying particular attention to toe and web areas, and under nails.
- Aqueous preparations are preferable to alcoholic lotions.
- Clothes and bedlinen should be washed at 50 degrees Celsius or above at time of treatment.
- In pregnancy or permethrin allergy, malathion in an aqueous basis is recommended.
- Heavily crusted scabies occurs in children who are immunosuppressed or immobile due to illness or disability. The antiscabetic agent should be applied daily for 3 days.
- Post scabies itch can persist for up to 2 months after eradication of the mites. It may be relieved by topical crotamiton, or topical menthol (see pruritis recommendations) an oral antihistamine and a moderately-potent topical steroid (see Eczema recommendations).
- For detailed guidance on correct application refer to British Association of Dermatologist Patient Information Leaflet for Scabies.
For further patient information refer to NHS Inform – Scabies. - Refer to local board guidance for scabies management, in NHS Lothian see staff intranet resources Health Protection> Scabies. In NHS Fife refer to Scabies guidance for GPs and community pharmacies [password protected].
History Notes
31/05/2024
East Region Formulary content agreed.
Dose according to age and product licence.
Dose according to age and product licence.
Prescribing Notes:
- Aqueous preparations are preferable to alcoholic lotions.
- All members of the household and close contacts should be treated.
- Clothes and bedlinen should be washed at least 60 degrees Celsius or above at time of treatment. Refer to CKS guidance on scabies management.
- Apply to cool dry skin (i.e. not after a hot bath).
- Consider sedating antihistamine for night time if itch interferes with sleep.
- Crotamiton (Eurax) cream or liquid may help soothe itch which may last for 2-3 weeks after treatment.
- For scabies, lotions/creams should be applied to the whole body, taking care to treat the webs of finger and toes, and brushing the preparation under the ends of finger nails.
History Notes
27/10/2020
Content migrated from ‘East Region Formulary: Pharmacy First - supporting minor ailments’ document.