Scabies Treatment

I was diagnosed with scabies a couple months ago and have not been able to get rid of them even after 4 tubes of permethrin 5% cream and fanatical cleaning.  I was thinking of seeing a new doctor, I am wondering if a dermatologist is best and if there is an alternative therapy available?  Thanks.

[Bhupinder Kaur, MD]

Hello,
The usual treatment of scabies is topical permethrin. It is the most effective scabicidal medication. Usually applied overnight and repeated weekly once for 2-3 weeks. The skin should be cool and dry before applying the anti-scabies medications. Avoid taking hot water baths before as this will cause the medication to be absorbed deeper. To be effective, the medication has to act on the superficial layers where the mite and its larvae reside.
Permethrin and oral ivermectin are the best treatment options of scabies. Sometimes itching of scabies persists for a few days after completion of treatment also and sometimes there may be recurrent and chronic cases which may require oral treatment of ivermectin. It is basically reserved for very severe, chronic and stubborn scabies that does not respond to conventional therapies.

So you should continue the permethrin treatment for a few days more and if the symptoms persist then oral ivermectin may need to be prescribed. There is a rule that all family members of the patient of scabies also need to be treated even if they do not have any itching or rashes. Hence please ensure that all your family members also get the topical treatment.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.