1. First line: Permethrin 5% cream (aqueous preparation available for children).  Okay in breastfeeding and pregnancy.
    • >12y age usually, up to one tube (30g). Some adults may need to use an additional tube for full body coverage but should not use more than 2 tubes (60g in total) at each application.
  2. Second line: Malathion 0.5% liquid.Okay in breastfeeding and pregnancy.
  3. Itch: crotamiton 10% cream.  Night time use of a sedative antihistamine (e.g. chlorphenamine or hydroxyzine).
Advice to offer patients

  • The product should usually be applied to the whole body from the chin and ears downwards paying special attention to the areas between the fingers and toes and under the nails, However, in people who are immunosuppressed, the very young, and elderly people, the insecticide should be applied to the whole body including the face and scalp.
  • The treatment should be applied to cool dry skin (not after a hot bath) and allowed to dry before the person dresses in clean clothes.
  • If you are prescribed Permethrin, it should be washed off after 8 to 12 hours.  If you are prescribed malathion it should be washed off after 24 hours. Body areas that are washed within 8 hours of permethrin application or 24 hours of malathion application should be treated again.
  • Mittens can be used to prevent infants putting treated hands in their mouths.
  • A second application is required one week after the first.
  • Breastfeeding women should remove the treatment from the nipples before feeding, and reapply afterwards
  • All members of their household, their sexual partners within the past month, and any other close personal contacts (even if no symptoms) should also be treated.
  • Bedding, clothing, and towels (and those of all potentially infested contacts) should be decontaminated by washing at a high temperature (at least 60°C) and drying in a hot dryer, or dry-cleaning, or by sealing in a plastic bag for at least 72 hours.
  • Itching may continue for up to two weeks after successful treatment of scabies, however, if itching persists for longer than 2–4 weeks after the last treatment application, advise the person to seek follow-up.
  • A patient information leaflet on scabies is available from the British Association of Dermatologists (


  1. CKS: Scabies


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