Management & Treatment
The goals of scabies treatment are threefold: 1) eradicate mites, 2) control symptoms, 3) prevent secondary infection

Permethrin:

5% Permethrin is a topical cream that is generally regarded as the primary scabicide. It has been demonstrated to be slightly more effective than Lindane in treating the infection. The cream should be applied liberally over the entire body save the head and ears. After 8 hours, the infected person should rinse off the Permethrin and repeat treatment 1 week later. The downside is that Permethrin is relatively expensive; 60g is sold wholesale to pharmacists for $30 (1oz is needed per treatment). The only exceptions are that Permethrin is not licensed for non-prescription use in children under 2 and that medical supervision is necessary with elderly patients and pregnant women.

Lindane:

Lindane is another topical scabicide - it is used in the same fashion as Permectin; the two drugs produce similar effects. However, with repeated applications, Lindane may be neurologically toxic. This factor, in conjunction with the observation that some patients cannot tolerate topical treatment (it may elicit burning and/or stinging), limits the use of Lindane in clinical settings.

Ivermectin:

Ivermectin is taken orally in CDC-recommended dosages of 200 ug/kilo body weight. Ivermectin is effective because it does not cross the blood-brain barrier, but instead interrupts glutamate-induced and gamma-aminobutyric acid-induced neurotransmission in parasites. The drug therefore causes paralysis, and ultimately death, of the mite. Clinical experience thus far suggests that while costly ($34 for 5 3-mg tablets), Ivermectin is safe to use.

-In behavioral terms, infected individuals should take care to wash all clothes and bed linens. It is critical that all family members take part in this practice; neglecting to do so is a common mistake and one that often results in recurrence.

-Following scabicide treatment, topical steroids are used to control inflammation. Antihistamines & lotions can help mitigate itchiness, while oral and topical antibiotics (particularly Mupirocin) are prescribed for secondary bacterial infections.

-Even if scabies is correctly treated, the itching can persist for up to 4 weeks (dead mites, eggs, and scybala will continue to elicit allergic reactions). However, neither new burrows nor new rashes should appear following treatment.

-Norwegian (Crusted) scabies is generally a relapsing condition that is resistant to therapy. A helpful technique is to remove the crusts, which both reduces the mite burden and increases treatment efficacy.

-Pregnant women and infants younger than two months are often given crotamiton or precipitated sulfur, both of which are safe to use but not particularly efficacious.

Infection in the finger webbing is common