Scabies diagnosis and contact treatment — Rapid

Synopsis

Recognise ordinary and crusted scabies, confirm uncertain disease, treat the whole skin field correctly, coordinate simultaneous close-contact treatment and distinguish persistent post-scabetic itch from failure.

Suspect scabies with new intense nocturnal itch, affected close contacts, burrows and papules at finger webs, wrists, axillae, waist, buttocks, genitalia or areolae.
In infants, older people and immune compromise, scalp, face, palms and soles may be involved; crusted scabies can itch little despite huge mite burden.
Apply permethrin 5% cream to the complete recommended skin field, including under nails and between digits, leave 8–12 hours and repeat after seven days.
Reapply to hands if washed during the contact period and do not miss buttock cleft, genital skin, soles or beneath jewellery.
Treat all household and sexual contacts simultaneously even if asymptomatic, because first infestation may not itch for weeks.
Wash recently used clothes, towels and bedding hot where possible or seal unwashable items for at least 72 hours according to outbreak advice.
Itch can persist four to six weeks after effective treatment; new burrows or new typical lesions are stronger evidence of failure than itch alone.
Crusted scabies needs urgent dermatology, infection-control and UKHSA-coordinated combined topical and oral therapy.

Key red flags

Crusted scabies, institutional outbreak, secondary sepsis, pregnancy or infancy with treatment uncertainty, severe immune or neurological impairment, eye exposure or persistent disease after correctly coordinated courses requires specialist or UKHSA support.

Crusted scabies

Extensive hyperkeratotic scale, fissures and nail debris in a vulnerable host indicates highly infectious hyperinfestation.

Secondary infection

Honey crust, spreading warmth, pain, pus or fever suggests bacterial complication requiring separate assessment.

Investigation priorities

Dermoscopy of a burrowFirst step

Visualise a mite and guide scraping in uncertain disease.

Management branches

Ordinary scabiesTreat patient and contacts together

Typical itch, distribution or confirmed mites occurs without crusted disease.

Apply permethrin 5% to the complete age-appropriate skin field for 8–12 hours, reapplying washed hands.
Repeat after seven days and treat household and sexual contacts on both dates regardless of symptoms.
Decontaminate recent textiles, treat secondary eczema and review new burrows rather than itch alone.

Key medicines

Permethrin 5% creamApply to the entire recommended skin surface, leave for 8–12 hours, wash off and repeat the complete application after seven days.Avoid eyes and mucosa, reapply after hand washing, use age- and pregnancy-specific advice, and recognise transient burning and persistent post-treatment itch.

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