• Permethrin 5% cream = first-line topical therapy in many guidelines.
• Apply thoroughly to the entire body from the neck down, including interdigital spaces, between the toes, under the nails, umbilicus, genital region, and buttocks.
• Leave on for approximately 8–14 hours, then wash off.
• Repeat approximately 7 days later to eradicate newly hatched mites.
• In infants, young children, older adults, or when the scalp is involved, treatment should also include the scalp and appropriate facial areas while avoiding the eyes and mouth.
• Alternative or appropriate treatment in selected patients: oral ivermectin 200 µg/kg, generally repeated 7–14 days later.
• Treat household members and close contacts simultaneously, even when asymptomatic when indicated by exposure and local recommendations.
• Wash recently used clothing, towels, and bedding using a hot cycle and hot dryer; items that cannot be washed can be sealed away for several days.
• Pruritus may persist for several weeks after successful treatment and does not necessarily indicate treatment failure.
• Crusted scabies generally requires combined oral ivermectin + topical permethrin using repeated doses/applications, along with contact precautions and specialist-directed management.
