- Permethrin 5% cream is first-line treatment; aqueous malathion is 2nd-line. If the first course doesn’t work, try the other one.
- Everyone in the family needs to be treated simultaneously, and all clothing (including clothes which have been worn but are hanging in the cupboard), towels and bedding need to be washed at the same time.
- Remember about getting treatment into all skin creases (finger webs, under breasts, around scrotum) and over scalp and any facial lesions in infants. Then reapply after one week.
- Don’t treat infants under 2 months. In all infants under 6 months, the diagnosis should be confirmed by a dermatologist.
- The lesions and itching can take several months to resolve; however, if treatment has been successful then no new lesions should appear. Treat secondary eczematisation with emollient and steroid.
- Refer patients with recurrent scabies to secondary care to make sure diagnosis is correct.
(BMJ Quick Quiz module)