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Scabies

What's new

The British Association for Sexual Health and HIV (BASHH) has updated its guidelines on the management of scabies. First-line treatment options include permethrin cream and oral ivermectin. Alternatives include malathion lotion and benzyl benzoate emulsion (not available in the U.S.). For crusted scabies, treatment should include a topical keratolytic agent (such as lactic acid and urea in sorbolene cream) along with both topical and oral antiparasitic agents. Contact tracing and notification of partners, household members, and other close contacts from the previous 2 months before symptom onset is recommended. Contacts should be treated even if asymptomatic, as symptoms may take up to 6 weeks to appear. .

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of scabies are prepared by our editorial team based on guidelines from the British Association for Sexual Health and HIV (BASHH 2025), the American Academy of Family Physicians (AAFP 2019), and the International Union Against Sexually Transmitted Infections (IUSTI 2017).
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Screening and diagnosis

Diagnosis: as per AAFP 2019 guidelines, suspect scabies in patients with a pruritic, papular rash in the typical distribution and pruritus in close contacts. Recognize that the classic burrows in webs and creases may not be present.
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Diagnostic investigations

Screening for STIs: as per BASHH 2025 guidelines, offer screening for other STIs in patients with scabies.
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Medical management

First-line therapy: as per BASHH 2025 guidelines, offer any of the following as first-line therapy for uncomplicated classical scabies:
permethrin 5% cream, applied and left for 12 hours; reapplied 1-2 weeks later given that one cream application often does not achieve full skin coverage
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ivermectin PO 200 mcg/kg on day 1 follewed by a second dose on day 8
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; second dose can be taken up to day 15 if necessary.
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More topics in this section

  • Alternative treatment options

  • Management of crusted scabies

  • Management of resistant disease

  • Management of contacts

  • Management of post-scabies itch

  • Management of bacterial infection

Nonpharmacologic interventions

Decontamination measures: as per BASHH 2025 guidelines, provide advice regarding laundry and other fomite decontamination measures, alongside treatment recommendations.
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Specific circumstances

Pregnant patients: as per BASHH 2025 guidelines, offer permethrin 5% cream in breast/chest-feeding or pregnant patients.
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Patient education

General counseling
As per BASHH 2025 guidelines:
Inform patients with scabies about its transmission through skin-to-skin contact, particularly between sexual partners and people living in the same household, and secondarily by fomite transmission.
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Advise patients on the correct methods of decontaminating or quarantining potential fomites.
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Preventative measures

Secondary prevention: as per BASHH 2025 guidelines, co-ordinate treatment, where possible, to ensure that both patients with scabies and all relevant contacts are treated correctly at the same time to avoid recurrence.
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Follow-up and surveillance

Monitoring: as per BASHH 2025 guidelines, consider obtaining a face-to-face review 4-6 weeks after the last administration of scabicide to evaluate the cure of the patient, prevent re-infestation from untreated contacts or from failure to follow laundry and cleaning advice, and to limit unnecessary repeat self-treatments.
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