1st line: Permethrin 5% cream [aqueous preparation available for children]
2nd line: Malathion 0.5% liquid [of choice in pregnancy and breastfeeding]
The entire body, except head and neck, must be treated. The lotion is applied with a small paint brush or cotton wool ball and allowed to dry before the patient redresses. The treatment is applied to cool dry skin and is applied to the whole body (except the head and neck), paying particular attention to the webs of the fingers and toes. It is important that nails should be clipped back and any debris removed before applying treatment.
In children up to about 2 years of age, immunocompromised patients, older people and in people in whom treatment has failed, application should be extended to neck, ears, face and scalp.
The application can be washed off in a hot bath after 8-12 hours (permethrin preparations). Malathion preparations are washed off after 24 hours.
Repeat treatment after 1 week.
Clothing and bed linen should be washed and all household and close contacts treated simultaneously even in the absence of symptoms.
Information sheet: http://www.patient.co.uk/health/scabies