Synopsis
Recognise classic and crusted scabies, treat the entire exposure network correctly and distinguish lice and environmental ectoparasites requiring different examination, product and control pathways.
- Scabies is caused by Sarcoptes scabiei mites burrowing in the stratum corneum; intense nocturnal itch and similarly affected close contacts are key clues.
- Typical burrows and papules involve finger webs, flexor wrists, axillae, waist, buttocks, genital skin and breasts; the adult head is usually spared.
- First-line treatment is permethrin 5% cream applied meticulously to the whole required skin surface, left for 8 to 12 hours and repeated after seven days.
Key red flags
Hyperkeratotic widespread scale or crust in immune compromise suggests highly contagious crusted scabies.
Thick widespread scale, fissuring and crusting with variable itch in frailty or immune compromise indicates a very high mite burden.
Investigation priorities
Identify distribution, burrows, nodules, crusting, secondary infection and commonly missed treatment sites.
Management branches
Clinical or microscopic findings support classic scabies without crusted disease.
- Provide written instructions and enough permethrin 5% cream to cover the whole required surface, including folds, genital skin, buttock cleft, soles, interdigital and subungual sites.
- Apply to cool dry skin, leave for 8 to 12 hours, reapply to hands after washing and wash off after the exposure period.
Key medicines
Permethrin 5% creamApply thoroughly to the whole required skin surface, leave for 8 to 12 hours, wash off and repeat the complete treatment after seven days.
Malathion 0.5% aqueous liquidApply to the whole required skin surface, leave for 24 hours, wash off and repeat after seven days when selected as an alternative.