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.
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.
Extensive hyperkeratotic scale, fissures and nail debris in a vulnerable host indicates highly infectious hyperinfestation.
Investigation priorities
Visualise a mite and guide scraping in uncertain disease.
Management branches
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.
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.