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Official reprint from UpToDate®

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Scabies: Management
Authors: Beth G Goldstein, MD, Adam O Goldstein, MD, MPH
Section Editors: Robert P Dellavalle, MD, PhD, MSPH, Moise L Levy, MD, Ted Rosen, MD
Deputy Editor: Abena O Ofori, MD

All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: Jun 2021. | This topic last updated: Feb 04, 2021.

INTRODUCTION

Scabies is a cutaneous infestation caused by the mite Sarcoptes scabiei. Classic scabies is
typically characterized by an intensely pruritic eruption with small, often excoriated,
erythematous papules in sites such as the fingers, wrists, axillae, areolae, waist, genitalia, and
buttocks. Crusted scabies, a less common clinical variant, typically presents with scaly, crusted,
fissured plaques and primarily occurs in immunocompromised individuals. (See "Scabies:
Epidemiology, clinical features, and diagnosis".)

The successful management of scabies involves the eradication of mites from the affected
person, management of associated symptoms and complications, assessment for additional
individuals who may require treatment, and implementation of measures to minimize
transmission and recurrence of infestation. Factors such as the clinical variant, patient
characteristics, and the setting of infestation influence the selection of interventions.

The management of scabies will be reviewed here. The clinical manifestations and diagnosis of
scabies are discussed separately. (See "Scabies: Epidemiology, clinical features, and diagnosis".)

ERADICATION OF INFESTATION

The approach to the eradication of scabies mites is dependent upon the clinical presentation
(classic, crusted, or endemic scabies) and patient population (see 'Special populations' below).
Treatment of both the patient and close personal contacts is suggested to prevent recurrent
infestation. (See 'Contacts and environment' below.)

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Classic scabies — The availability of antiscabietic agents for classic scabies varies worldwide
[1,2]. Topical permethrin and oral ivermectin are the most common first-line treatments in the
United States, United Kingdom, and Australia [3]. Benzyl benzoate, topical sulfur, crotamiton,
lindane, and topical ivermectin are examples of other treatments. (See 'Other agents' below.)

First-line therapies — Topical permethrin is highly effective for scabies, with cure rates in
randomized trials approximating or exceeding 90 percent [4,5]. Oral ivermectin is an alternative
first-line treatment that has the advantages of ease of administration and lower cost. Special
considerations are warranted for young children and pregnant women. (See 'Special
populations' below.)

Permethrin — Permethrin is a topical synthetic pyrethroid agent that impairs function of

voltage-gated sodium channels in insects, leading to disruption of neurotransmission [6]:

● Administration – Patients should massage permethrin cream thoroughly into the skin
from the neck to the soles of the feet, including areas under the fingernails and toenails [7].
Thirty grams is usually sufficient for a single application for an average adult. In young
children, scalp involvement is common. Therefore, permethrin should also be applied to
the scalp and face (sparing the eyes and mouth) in this population. Permethrin should be
removed by washing (shower or bath) after 8 to 14 hours. Treatment is often performed
overnight.  

A second application one to two weeks later may be necessary to eliminate mites and is
typically performed [6,8]. However, the relative efficacy of one versus two applications of
permethrin has not been studied.

Limited data suggest that other regimens may also be effective [9].

● Efficacy – High-quality trials comparing scabies treatments are limited [4,5]. In a systematic
review and meta-analysis of randomized trials, topical permethrin and oral ivermectin
appeared similarly effective [10]. A network meta-analysis of 52 randomized trials that
compared a topical or oral intervention for scabies with placebo or another therapy found a
higher cure rate for permethrin compared with other topical therapies, including sulfur,
malathion, lindane, crotamiton, and benzoyl benzoate [11].

● Adverse effects – Permethrin is generally well tolerated. Skin irritation is a potential side
effect.

Oral ivermectin — Oral ivermectin is an antiparasitic alternative to permethrin that has

the advantage of ease of administration. This mode of treatment may be particularly useful for

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large scabies outbreaks in nursing homes and other facilities where topical therapy can be
impractical. Oral ivermectin is not a recommended first-line treatment for pregnant or lactating
women and children who weigh less than 15 kg (see 'Special populations' below):

● Administration – Ivermectin therapy for classic scabies consists of a 200 mcg/kg single
dose followed by a repeat dose after one to two weeks [12-14].

● Efficacy – Various studies support the efficacy of oral ivermectin. One randomized trial (n =
55) found a higher cure rate at seven days with single-dose ivermectin (200 mcg/kg) than
placebo (79 versus 16 percent) [15]. In addition, based upon a systematic review and meta-
analysis of randomized trials, oral ivermectin appears to be as effective as topical
permethrin [10].

● Adverse effects – Oral ivermectin is generally well tolerated in patients treated for scabies.
Most, but not all, reports of severe adverse effects have occurred in patients with
helminthic infections [16-18]. The validity of an isolated report of increased deaths among
residents of a nursing home treated with oral ivermectin for scabies has been questioned
[19-21].

Other agents — Additional topical treatment options for scabies include benzyl benzoate,
topical sulfur, crotamiton, and malathion [1,3,12,22]. These agents have not been shown to be
more effective than topical permethrin [4,5,11]. Topical ivermectin is a newer, albeit high-cost,
agent that appears to have efficacy for scabies [23-25]. In an open-label, randomized trial that
compared permethrin, topical ivermectin, and oral ivermectin, cure rates for permethrin and
topical ivermectin were similar [23].

Benzyl benzoate (10 or 25%) is commonly used in resource-limited countries because of the
drug's low cost. Treatment regimens vary; the drug may be applied once daily at night on two
consecutive days, with a repeat treatment cycle after seven days [1]. Benzyl benzoate is not
available in the United States.

Topical sulfur (6 to 33%) is relatively inexpensive and primarily used for the treatment of
neonates and pregnant women. Sulfur ointment is applied overnight for three consecutive
days. In the United States, the drug must be compounded. We typically prescribe 240 g of 8 or
10% precipitated sulfur in petrolatum for adults. (See 'Special populations' below.)

Use of lindane has fallen out of favor due to risk for systemic toxicity (eg, seizures, death) [1,12].
Lindane should be used only as an alternative therapy in patients who cannot tolerate other
therapies or when other therapies have failed [12]. A thin layer of lindane 1% (1 oz of lotion or
30 g of cream) is applied to all areas of the body from the neck down and thoroughly washed
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off after eight hours [12]. European and Japanese guidelines recommend against use of this
therapy [1,2]. Lindane lotion or cream is not available in the United States. (See "Pediculosis
capitis", section on 'Lindane toxicity'.)

The treatment regimen for crotamiton is not standardized. The drug can be applied to the
entire body from the chin down, reapplied 24 hours later, and washed off 48 hours after the last
application [26]. Regimens consisting of application for up to five successive days or longer
have also been utilized [2]. In randomized trials, crotamiton has appeared less effective than
permethrin [5,27].

Malathion 0.5% lotion has been used for scabies based upon case series that suggest efficacy
[5]. A single application is typically performed. Malathion is applied to the skin at night and
washed off after 8 to 12 hours [1]. Disadvantages of malathion include flammability of the
product and relatively high cost.

Crusted scabies — Combination treatment with permethrin and oral ivermectin is considered

the preferred first-line treatment for crusted scabies [6,14]. Treatment with permethrin alone
requires repeated applications, and the failure rate is significant. In case reports and case
series, oral ivermectin combined with topical therapy has been effective [28-31].  

We agree with the United States Centers for Disease Control and Prevention's combination
regimen for the treatment of crusted scabies [32]:

● Permethrin 5% cream applied every two to three days for one to two weeks. Topical benzyl
benzoate (25% for adults, 10 or 12.5% for children) is an alternative to permethrin.

And

● Oral ivermectin (200 mcg/kg/dose) given for 3, 5, or 7 nonconsecutive days depending on

severity of infestation (approximately days 1, 2, and 8; approximately days 1, 2, 8, 9, and 15;
or approximately days 1, 2, 8, 9, 15, 22, and 29).

Concomitant use of topical keratolytic creams may help to reduce crusting [32].

The use of lindane is contraindicated in patients with crusted scabies due to risk for toxicity.
(See "Pediculosis capitis", section on 'Lindane toxicity'.)

Endemic scabies — Mass drug administration, which involves repeat administration of single

doses of therapeutic agents to the entire community, has been shown to be an effective control
strategy for scabies in hyperendemic areas [13,33-36]. Oral ivermectin is our preferred
intervention given the drug's efficacy and ease of administration.

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The Skin Health Intervention Fiji Trial (SHIFT), involving three island communities with a scabies
prevalence >20 percent, compared the efficacy of three approaches: mass administration of a
single dose of oral ivermectin 200 mcg/kg of body weight, mass administration of a single dose
of topical permethrin, and standard treatment (topical permethrin treatment only for persons
with scabies and their contacts) [13]. Participants with scabies received a second dose of the
assigned medication after 7 to 14 days. The primary outcome was the change in the prevalence
of scabies and impetigo from baseline to 12 months. At 12 months, the prevalence of scabies
had declined by 94 percent (95% CI 83-100 percent) in the ivermectin group, 62 percent in the
permethrin group (95% CI 49-75 percent), and 49 percent (95% CI 37-60 percent) in the
standard-care group. The prevalence of impetigo was reduced by 67, 54, and 32 percent in the
three groups, respectively. Adverse effects were mild but more common in the ivermectin
group than in the permethrin group (16 versus 7 percent).

Special populations

Children — Given its high efficacy and safety, permethrin is our preferred therapy. However,
topical sulfur is typically used for the treatment of infants under the age of two months because
of lack of regulatory approval for permethrin use in infants in this age group. Lindane should
not be given to children under the age of 10 years because of risk for systemic toxicity [12].

Treatment with oral ivermectin is not recommended for children who weigh less than 15 kg [1].
The safety of oral ivermectin has not been determined in this population. Although a
retrospective study of the efficacy and tolerability of oral ivermectin for scabies in infants under
15 kg found that 12 of 14 achieved resolution of clinical features of scabies within one month
and documented few adverse events [37], additional data are needed before use of this drug in
infants with scabies can be recommended.

Pregnant women — Permethrin is considered safe for use in pregnant and lactating women
and is a preferred treatment [12]. Systemic absorption is low, and the drug is metabolized
quickly.

Second-line treatments for pregnant women include topical sulfur and benzyl benzoate [1,38].
Although risk associated with oral ivermectin may be low, data on use in this population are
limited [12].

Assessment for cure and treatment failure — Therapy is likely successful if active lesions
resolve and nocturnal pruritus ceases by one week after treatment [1]. Of note, some pruritus
often persists for two to four weeks after successful treatment.

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Common causes for pruritus beyond four weeks include treatment failure and treatment-
related skin irritation or contact dermatitis [22]. Treatment failure may result from poor
adherence to the treatment regimen, resistance, or reinfestation. If resistance appears to be
the most likely cause of treatment failure, treatment with an alternative antiscabietic agent
should be attempted [22]. Other causes of persistent pruritus include delusional infestation
(also called delusional parasitosis) and unrelated skin disease.

When persistent active scabies is suspected, a physical examination and scabies preparation
can aid in detecting active infestation. (See "Scabies: Epidemiology, clinical features, and
diagnosis", section on 'Diagnosis'.)

SYMPTOMS AND COMPLICATIONS

The management of scabies should include treatment of associated conditions such as pruritus,
secondary infection, and cutaneous nodules.

Pruritus — Antihistamines may improve pruritus, which may persist for up to four weeks after
successful treatment [22]. We typically prescribe a nonsedating antihistamine during the day
and a sedating antihistamine at night.

After eradication of mites, medium- or high-potency topical corticosteroids ( table 1) can also
be prescribed to control itching [39]. In severe cases, patients can be treated with an oral
glucocorticoid taper over one to two weeks, starting with 40 to 60 mg of prednisone daily for
adults.

Symptoms should progressively improve with adequate therapy. If symptoms worsen despite
adequate treatment, the possibility of re-exposure or an alternative diagnosis should be
considered. (See 'Assessment for cure and treatment failure' above.)

Secondary infection — Pyoderma should be treated with appropriate systemic antibiotics.

Streptococcal infections associated with scabies have resulted in glomerulonephritis [40]. (See
"Scabies: Epidemiology, clinical features, and diagnosis", section on 'Complications'.)

Nodules — Nodules from scabies may persist after eradication of mites. Dermoscopy may be
helpful for identifying patients with residual active disease [41]. (See "Scabies: Epidemiology,
clinical features, and diagnosis", section on 'Classic scabies'.)

Nodules can be treated with once- to twice-daily application of a potent topical steroid for two
to three weeks or intralesional injection of a corticosteroid such as triamcinolone acetonide (5
to 10 mg/mL) ( table 1) [42]. Intralesional corticosteroid injections may also be useful for
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nodules that fail to respond adequately to topical corticosteroid therapy. The injection volume
should just make the lesion blanch; typically, 0.1 mL per nodule is adequate. Cutaneous atrophy
is a potential side effect of topical intralesional corticosteroid therapy. (See "Topical
corticosteroids: Use and adverse effects", section on 'Adverse effects' and "Intralesional
corticosteroid injection", section on 'Side effects, complications, and pitfalls'.)

Limited data suggest that topical calcineurin inhibitors may be beneficial. Improvement of
nodules after treatment with topical tacrolimus 0.03% ointment has been documented in a
small case series, and topical pimecrolimus appeared effective in a case report [43,44].
Resolution of nodules following cryotherapy also has been reported [45]. Additional studies are
needed to confirm the efficacy of these treatments.

CONTACTS AND ENVIRONMENT

The onset of symptoms of scabies is often delayed for several weeks; therefore, close personal
contacts may have active scabies even in the absence of symptoms. As a result, simultaneous
treatment of cohabitants and individuals with prolonged physical contact is generally practiced
to avoid an endless cycle of transmission and reinfestation [46]. However, high-quality
randomized trials to confirm the efficacy of this practice and to determine the best treatment
regimen are lacking [47]. Close personal contacts are typically treated with the same regimens
used for classic scabies. (See 'Classic scabies' above.)

In addition, environmental measures are suggested with the goal of minimizing risk for
transmission or reinfestation. Scabies mites generally do not survive for more than two to three
days away from human skin; therefore, such measures are focused on items and areas in
contact with the patient over the preceding several days. General environmental measures
include laundering or sequestering items that came in close, prolonged contact with the
infested individual and adequate cleaning of rooms inhabited by patients with crusted scabies.
A more aggressive approach is indicated in institutional settings to minimize risk for
transmission to other patients and staff [8]. Fomite transmission is most likely to occur in the
setting of crusted scabies given the associated high mite burden (up to millions of mites). (See
"Scabies: Epidemiology, clinical features, and diagnosis", section on 'Transmission'.)

Application of pesticides is not indicated in either the home or institutional setting.

Community setting — The patient and cohabitants or other individuals who have had
prolonged skin-to-skin contact in the preceding six weeks should be treated simultaneously.

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Because symptoms of scabies may be delayed for up to six weeks in newly infested individuals,
the absence of symptoms does not confirm the absence of infestation.

Ideally, the patient should inform and encourage such contacts to seek medical attention for
treatment [48]. Although commonly practiced, treatment of cohabitants without an
examination performed by the prescribing clinician is controversial. Local policies regarding
legality of this practice (ie, expedited partner therapy) vary [49].

In addition, items used within the preceding several days (clothing, linens, stuffed animals, etc)
can be placed in a plastic bag for at least three days or washed with hot water and then ironed
or dried in a hot dryer [12]. Dry cleaning is an alternative. Rooms used by patients with crusted
scabies should be thoroughly cleaned and vacuumed.

Institutional setting — In the institutional setting, a diagnosis of scabies should trigger

heightened awareness to facilitate the identification and treatment of additional individuals
with scabies. In the setting of multiple individuals with classic scabies or at least one patient
with crusted scabies, the institution should implement an institution-wide education program
about scabies. Notification of the local health department is indicated if there is potential for
spread beyond the institution [8].

Suggested general management measures for asymptomatic individuals who are or have been
in contact with a patient with classic scabies include [8]:

● Adherence to appropriate infection control measures when handling patients (eg,

avoidance of direct skin-to-skin contact, handwashing)

● Treatment of staff, other patients, and household members who had prolonged skin-to-
skin contact with the patient

● Avoidance of skin-to-skin contact with the patient until at least eight hours after treatment

● Laundering of clothing and bedding of the affected patient with a washing machine and
dryer utilizing hot water and hot, dry cycles

● Routine cleaning and vacuuming of the room after the patient is discharged from the room

Rapid identification and treatment of crusted scabies is essential to minimize dissemination of

the infestation. Institutional infection-control personnel should be contacted immediately, and
the patient should be isolated from other patients in the institution. Suggested general
management measures following a diagnosis of crusted scabies include [8]:

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● Prompt involvement of institutional infection-control personnel.

● Isolation of the affected patient from other patients.

● Assignment of a dedicated care team for the patient to minimize exposure of staff, if
feasible.

● Strict contact precautions, including avoidance of direct skin-to-skin contact with the
patient and use of protective gowns, gloves, and shoe covers, until the patient has been
treated and a scabies preparation is negative.

● Frequent cleaning of the patient's room to remove contaminated scales and crusts;
thorough cleaning and vacuuming of the room after the patient is discharged from the
room.

● Laundering of clothing and bedding with a washing machine and dryer utilizing hot water
and hot dryer settings; utilization of protective clothing and gloves by laundry personnel.

● Treatment of all individuals (eg, staff, visitors, family members) who came in direct physical
contact with the patient or clothing, bedding, or furniture.

The United States Centers for Disease Control and Prevention provides detailed
recommendations for the management of scabies in institutional settings [50]. Local health
departments are another useful resource.

RETURN TO WORK OR SCHOOL

Individuals with classic scabies can return to work, child care, or school the day after the first
treatment [8]. This is appropriate provided treatment has been administered correctly and the
patient agrees to complete the prescribed course of treatment.

SOCIETY GUIDELINE LINKS

Links to society and government-sponsored guidelines from selected countries and regions
around the world are provided separately. (See "Society guideline links: Scabies".)

INFORMATION FOR PATIENTS

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UpToDate offers two types of patient education materials, "The Basics" and "Beyond the
Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade
reading level, and they answer the four or five key questions a patient might have about a given
condition. These articles are best for patients who want a general overview and who prefer
short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more
sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading
level and are best for patients who want in-depth information and are comfortable with some
medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print
or e-mail these topics to your patients. (You can also locate patient education articles on a
variety of subjects by searching on "patient info" and the keyword(s) of interest.)

● Basics topics (see "Patient education: Scabies (The Basics)")

● Beyond the Basics topics (see "Patient education: Scabies (Beyond the Basics)")

SUMMARY AND RECOMMENDATIONS

● Scabies is a common cutaneous infestation caused by the mite Sarcoptes scabiei.

Management involves:

• Eradication of mites from the affected person

• Management of associated symptoms and complications

• Assessment for additional individuals who may require treatment

• Implementation of measures to minimize transmission and reinfestation (see

'Introduction' above)

● Classic scabies, the most common presentation of scabies, can be treated with either
topical or oral therapy. We suggest topical permethrin or oral ivermectin for first-line
treatment of adults (Grade 2B). We suggest treating crusted scabies with a combination of
permethrin and ivermectin (Grade 2C). (See 'Classic scabies' above and 'Crusted scabies'
above.)

● Signs of successful treatment include resolution of active skin lesions and nocturnal
pruritus one week after treatment. However, some pruritus often persists for up to four
weeks after successful treatment. Examples of causes of pruritus beyond this period

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include treatment failure, treatment-related skin irritation or contact dermatitis, persistent

infestation, or reinfestation. (See 'Assessment for cure and treatment failure' above and
'Pruritus' above.)

● Nodules that persist after eradication of mites can be treated with potent topical
corticosteroids or intralesional corticosteroid injections. (See 'Nodules' above.)

● The onset of symptoms from scabies may be delayed for several weeks after infestation.
Thus, individuals who have been in close personal contact with a patient with classic
scabies may have active scabies even in the absence of symptoms. We suggest treating
patients and individuals who have had prolonged skin-to-skin contact with patients with
classic scabies simultaneously (Grade 2C). (See 'Contacts and environment' above.)

● Occurrences of scabies in institutional settings require prompt attention to minimize risk

for transmission to other individuals. A rapid response is particularly important in the
setting of crusted scabies. (See 'Institutional setting' above.)

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community intervention trial. Lancet Infect Dis 2019; 19:510.

36. Marks M, Romani L, Sokana O, et al. Prevalence of Scabies and Impetigo 3 Years After Mass
Drug Administration With Ivermectin and Azithromycin. Clin Infect Dis 2020; 70:1591.
37. Bécourt C, Marguet C, Balguerie X, Joly P. Treatment of scabies with oral ivermectin in 15
infants: a retrospective study on tolerance and efficacy. Br J Dermatol 2013; 169:931.
38. Müllegger RR, Häring NS, Glatz M. Skin infections in pregnancy. Clin Dermatol 2016; 34:368.
39. Johnston G, Sladden M. Scabies: diagnosis and treatment. BMJ 2005; 331:619.
40. Chung SD, Wang KH, Huang CC, Lin HC. Scabies increased the risk of chronic kidney
disease: a 5-year follow-up study. J Eur Acad Dermatol Venereol 2014; 28:286.
41. Suh KS, Han SH, Lee KH, et al. Mites and burrows are frequently found in nodular scabies
by dermoscopy and histopathology. J Am Acad Dermatol 2014; 71:1022.

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42. Karthikeyan K. Treatment of scabies: newer perspectives. Postgrad Med J 2005; 81:7.
43. Mittal A, Garg A, Agarwal N, et al. Treatment of nodular scabies with topical tacrolimus.
Indian Dermatol Online J 2013; 4:52.

44. Almeida HL Jr. Treatment of steroid-resistant nodular scabies with topical pimecrolimus. J
Am Acad Dermatol 2005; 53:357.
45. Zawar V, Pawar M. Liquid nitrogen cryotherapy in the treatment of chronic, unresponsive
nodular scabies. J Am Acad Dermatol 2017; 77:e43.
46. Chambliss ML. Treating asymptomatic bodily contacts of patients with scabies. Arch Fam
Med 2000; 9:473.
47. FitzGerald D, Grainger RJ, Reid A. Interventions for preventing the spread of infestation in
close contacts of people with scabies. Cochrane Database Syst Rev 2014; :CD009943.
48. Stoff BK, Introcaso C, Kinlaw K, Swerlick RA. Expedited partner therapy for scabies: legal
and ethical considerations. J Am Acad Dermatol 2013; 69:795.

49. https://www.cdc.gov/std/ept/default.htm (Accessed on December 11, 2020).

50. www.cdc.gov/parasites/scabies/health_professionals/institutions.html (Accessed on August
21, 2017).
Topic 114369 Version 7.0

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GRAPHICS

Comparison of representative topical corticosteroid preparations (classified according to the

United States system)

Available
Brand names
strength(s),
Potency group* Corticosteroid Vehicle type/form
(United States) percent

(except as noted)

Super-high potency
Betamethasone Gel, lotion, ointment Diprolene 0.05
(group 1) dipropionate, (optimized)
augmented

Clobetasol propionate Cream, gel, ointment, Temovate 0.05

solution (scalp)

Cream (emollient base) Temovate E ¶ 0.05

Lotion, shampoo, spray Clobex 0.05

aerosol

Foam aerosol Olux, Olux-E, Tovet 0.05

Lotion Impeklo 0.05

Ointment Clobetavix 0.05

Shampoo Clodan 0.05

Solution (scalp) Cormax ¶ 0.05

Diflucortolone valerate Ointment, oily cream Nerisone Forte (United 0.3

(not available in United Kingdom, others)
States)

Fluocinonide Cream Vanos 0.1

Flurandrenolide Tape (roll) Cordran 4 mcg/cm 2

Halobetasol propionate Cream, lotion, Ultravate 0.05

ointment

High potency
Amcinonide Ointment Cyclocort ¶, Amcort ¶ 0.1
(group 2) ¶
Betamethasone Ointment Diprosone 0.05
dipropionate
Cream, augmented Diprolene AF 0.05
formulation (AF)

Clobetasol propionate Cream Impoyz 0.025

Desoximetasone Cream, ointment, spray Topicort 0.25

Gel Topicort 0.05

¶ ¶
Diflorasone diacetate Ointment ApexiCon , Florone 0.05

Cream, emollient ApexiCon E 0.05

Fluocinonide Cream, gel, ointment, Lidex ¶ 0.05

solution

Halcinonide Cream, ointment, Halog 0.1

solution

Halobetasol propionate Lotion Bryhali 0.01

High potency
Amcinonide Cream Cyclocort ¶, Amcort ¶ 0.1
(group 3)
Lotion Amcort ¶ 0.1
¶
Betamethasone Cream, hydrophilic Diprosone 0.05

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dipropionate emollient

Betamethasone Ointment Valisone ¶ 0.1

valerate
Foam Luxiq 0.12
¶
Desoximetasone Cream Topicort LP 0.05
¶
Diflorasone diacetate Cream Florone 0.05

Diflucortolone valerate Cream, oily cream, Nerisone (Canada, 0.1

(not available in United ointment United Kingdom,
States) others)

Fluocinonide Cream aqueous Lidex-E ¶ 0.05

emollient

Fluticasone propionate Ointment Cutivate ¶ 0.005

Mometasone furoate Ointment Elocon 0.1

Triamcinolone Cream, ointment Aristocort HP ¶, 0.5

acetonide Kenalog ¶, Triderm

Medium potency
Betamethasone Spray Sernivo 0.05
(group 4) dipropionate

Clocortolone pivalate Cream Cloderm 0.1

Fluocinolone acetonide Ointment Synalar ¶ 0.025

Flurandrenolide Ointment Cordran 0.05

¶
Fluticasone propionate Cream Cutivate 0.05

Hydrocortisone Ointment Westcort 0.2

valerate

Mometasone furoate Cream, lotion, Elocon ¶ 0.1

ointment, solution

Triamcinolone Cream Kenalog ¶, Triderm 0.1

acetonide
Ointment Kenalog ¶ 0.1

Ointment Trianex 0.05

Aerosol spray Kenalog 0.2 mg per 2 second

spray

Dental paste Oralone 0.1

¶
Lower-mid potency
Betamethasone Lotion Diprosone 0.05
(group 5) dipropionate

Betamethasone Cream Beta-Val, Valisone ¶ 0.1

valerate

Desonide Ointment DesOwen, Tridesilon ¶ 0.05

Gel Desonate 0.05

¶
Fluocinolone acetonide Cream Synalar 0.025

Flurandrenolide Cream, lotion Cordran 0.05

Fluticasone propionate Lotion Cutivate 0.05

Hydrocortisone Cream, lotion, Locoid, Locoid 0.1

butyrate ointment, solution Lipocream

Hydrocortisone Cream Pandel 0.1

probutate

Hydrocortisone Cream Westcort ¶ 0.2

valerate

Prednicarbate Cream (emollient), Dermatop 0.1

ointment

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Triamcinolone Lotion Kenalog ¶ 0.1

acetonide ¶
Ointment Kenalog 0.025

Low potency
Alclometasone Cream, ointment Aclovate 0.05
(group 6) dipropionate

Betamethasone Lotion Beta-Val ¶, Valisone ¶ 0.1

valerate

Desonide Cream DesOwen, Tridesilon ¶ 0.05

Lotion DesOwen, LoKara 0.05

Foam Verdeso 0.05

Fluocinolone acetonide Cream, solution Synalar ¶ 0.01

Shampoo Capex 0.01

Δ
Oil Derma-Smoothe/FS 0.01
Body, Derma-
Smoothe/FS Scalp

Triamcinolone Cream, lotion Kenalog ¶, Aristocort ¶ 0.025

acetonide

Least potent
Hydrocortisone (base, Cream, ointment Hytone, Nutracort ¶ 2.5
(group 7) ≥2%)
Lotion Hytone, Ala Scalp, 2
Scalacort

Solution Texacort 2.5

Hydrocortisone (base, Ointment Cortaid, Cortizone 10, 1

<2%) Hytone, Nutracort

Cream Cortaid ¶, Cortizone 10, 1

Hytone, Synacort

Gel Cortizone 10 1

Lotion Aquanil HC, Sarnol-HC, 1

Cortizone 10

Spray Cortaid 1

Solution Cortaid, Noble, Scalp 1

Relief

Cream, ointment Cortaid 0.5

Hydrocortisone acetate Cream MiCort-HC 2.5

Lotion Nucort 2

* Listed by potency according to the United States classification system: group 1 is the most potent, group 7 is the least potent. Other
countries use a different classification system with only 4 or 5 groups.

¶ Inactive United States brand name for specific product; brand may be available outside United States. This product may be available
generically in the United States.

Δ 48% refined peanut oil.

Data from:
1. Lexicomp Online. Copyright © 1978-2021 Lexicomp, Inc. All Rights Reserved.
2. Tadicherla S, Ross K, Shenefelt D. Topical corticosteroids in dermatology. Journal of Drugs in Dermatology 2009; 12:1093.
3. U.S. Food & Drug Administration Approved Drug Products with Therapeutic Equivalence (Orange Book). Available at:
https://www.accessdata.fda.gov/scripts/cder/ob/default.cfm (Accessed on June 18, 2017).
4. The British Association of Dermatologists' information on topical corticosteroids – established and alternative proprietary names,
potency, and discontinuation. British Association of Dermatologists. Available at: https://www.bad.org.uk/shared/get-file.ashx?
id=3427&itemtype=document (Accessed on April 26, 2021).

Graphic 62402 Version 61.0

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Contributor Disclosures
Beth G Goldstein, MD Nothing to disclose Adam O Goldstein, MD, MPH Nothing to disclose Robert P
Dellavalle, MD, PhD, MSPH Equity Ownership/Stock Options: Altus Labs [Itch, eczema].
Grant/Research/Clinical Trial Support: Pfizer [Patient decision aids, inflammatory and immune-mediated
skin disease]. Consultant/Advisory Boards: Altus Labs [Itch, eczema]; ParaPRO [Scabies, lice]. Other
Financial Interest: Journal of Investigative Dermatology; Journal of the American Academy of Dermatology
[Stipends]; Cochrane Council meetings [Expense reimbursement]. Moise L Levy, MD Patent Holder:
Incontinentia pigmenti. Grant/Research/Clinical Trial Support: Fibrocell [Epidermolysis bullosa]; Galderma
[Atopic dermatitis]; Janssen Pharmaceutica [Psoriasis]; Pfizer [Atopic dermatitis]. Consultant/Advisory
Boards: Cassiopea [Pediatric and adolescent acne]; Regeneron Pharmaceuticals [Atopic dermatitis]; UCB
[Psoriasis]. Other Financial Interest: Mayne Pharma [Data safety monitoring board for ichthyosis trial];
Novan [Data safety monitoring board for molluscum contagiosum trial]. Ted Rosen,
MD Consultant/Advisory Boards: Foamix; Almirall [Acne]; DermTech [Melanoma]; Beiersdorf [Dry
skin]. Abena O Ofori, MD Nothing to disclose

Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are
addressed by vetting through a multi-level review process, and through requirements for references to be
provided to support the content. Appropriately referenced content is required of all authors and must
conform to UpToDate standards of evidence.

Conflict of interest policy

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