Page content: Overview | Treating cases | Treating contacts | Scabies infection control measures

Overview

Contact precautions should be employed for suspected cases until the diagnosis is excluded by skin scraping, and, if confirmed, until the day after appropriate therapy has been commenced. As skin scraping is not always positive in true cases, therapy may need to be commenced if the clinical suspicion remains high.

Treating cases

Residents and/or staff should be treated with Permethrin 5% cream (e.g. Lyclear, Quellada) topically, to the whole body including face, hair, behind ears and fingernails (avoid eyes and mucous membranes), leave 8 to 12 hours (e.g. overnight) or Benzyl benzoate 25% emulsion (e.g. Ascabiol, Benzemul 25%) topically, to the whole body including face, hair, behind ears and fingernails (avoid eyes and mucous membranes), leave for 24 hours. For adults with sensitive skin, dilute with equal parts water. Consult the current version of Therapeutic guidelines: antibiotic (Therapeutic Guidelines Limited).

A repeat treatment is advised 14 days after the first treatment, particularly for moderate to severe infestations.

Occasionally large nodular lesions (scabies nodules) can develop in the elderly. These can remain itchy for several months after successful treatment. In these circumstances the use of topical steroids (e.g. Betnovate cream, Elecon cream) may be necessary.

When crusted (Norwegian) scabies is suspected, a single oral dose of ivermectin is often prescribed in addition to the scabicide. Specialist infectious disease or dermatological advice should be sought.

Treating contacts

Close contacts without symptoms who have had recent close contact with cases should be advised of their possible exposure to scabies and be treated simultaneously as above, but with no repeat treatment required. Close contacts include:

• residents with recent close contact, including those who share the same room
• family members and regular visitors with recent close contact with the case
• staff members with recent close contact, including staff handling laundry items.

Close contacts with symptoms consistent with scabies, such as itch or rash, should be treated as if they were a case (see Treating cases, above).

Any agency staff should be notified as they will also need treatment, especially as many attend different health care facilities. If necessary notify the Agency in order to trace staff.
Everyone identified as needing treatment should ideally be treated within the same 24 to 48 hour period. Itch may persist for over 2 weeks after successful treatment and this does not signify treatment failure.

Scabies infection control measures

Linen and bed linen should be hot washed while the treatment application is on and linen used during the application period hot washed after the treatment is washed off.
Clothes and towels used by the affected persons in the 48 hours prior to treatment should be machine washed in hot water. Linen, blankets and clothing can also be dry cleaned or placed in a tumble dryer on a hot setting for half an hour, or sealed in a plastic bag for one week before laundering.