Visit your GP immediately if you get scabies and you have not had a previous infection. If you delay treatment, you risk passing scabies on to someone else.

As other, more serious skin conditions can sometimes cause similar symptoms to scabies, your GP will need to rule these out as a possible cause of your symptoms.

If another member of your household has already been diagnosed with scabies, visit your GP or nearest GUM clinic to be examined and treated to avoid passing on the infection.

Avoid having sex and other forms of close bodily contact until you and your partner have both completed the treatment.

Creams and lotions

The two most widely used treatments for scabies are:

• permethrin cream
• malathion lotion

Permethrin cream is usually recommended as the first treatment. Malathion lotion is used if the permethrin cream proves to be ineffective. Both medications contain insecticides that kill the scabies mite.

Permethrin cream should be used under medical supervision for women who are pregnant and also for young children who are between two months and two years old. You should check with your GP before using this treatment.

Malathion lotion has no known affects on women who are pregnant or breastfeeding. However, you should also seek advice from your GP or pharmacist before using malathion lotion. Children who are six years old and under should be medically supervised while being treated with malathion.

Applying the medication

It is important that all members of your household, and any close contacts (including recent sexual partners, see Scabies – diagnosis) are treated at the same time as you, even if they do not have symptoms. Otherwise, re-infection could occur.

The following advice relates to how permathrin cream and malathion lotion should be applied.

• Permathrin cream or malathion lotion should be applied to cool, dry skin and not after a hot bath. If the cream or lotion is applied when the body is hot, it will be absorbed quickly into the skin and will not remain on the area where the burrows are present.
• Apply it to the whole body from the chin and ears downwards, paying particular attention to the areas between the fingers and toes and under the nails and areas where there are skin folds. Treatment can be massaged under fingernails and toenails using an old toothbrush (which should be sealed in a bag and thrown away afterwards).
• Adults should not apply lotion above the neck. However, in children under two years old a thick layer should be applied to the scalp, face and ears, avoiding the eyes and mouth.
• People with a weak immune system, the very young and elderly people should apply the treatment to their whole body, including their face and scalp.
• If you wash your hands within 8–12 hours, reapply the cream to your hands, making sure that you also put it under your nails. 
• Permethrin needs to be left on for 8–12 hours, and malathion should be left on for 24 hours. 
• Follow-up treatment after seven days is recommended in order to make sure that the treatment is successful. This will ensure that any mites that have hatched from existing eggs will be killed by the second application.

Follow up

Contact your GP if the symptoms of itching do not improve after two weeks of treatment and you notice new burrows appearing on your skin. They may recommend that the treatment is repeated or prescribe a different lotion that you can use.

Side effects

You may experience side effects after using permethrin or malathion. Possible side effects of permethrin include:

• itching
• skin irritation
• numbness
• a tingly sensation
• stinging on application

See your GP or pharmacist if these side effects persist.

Skin irritation can also occur after using malathion. Again, you should visit your GP or pharmacist if you have this side effect and it persists or gets worse.

Infection control

On the day that you first apply the cream, wash all clothes, bed linen and towels at above 50C (122F). If you are unable to wash certain items, place them in a plastic bag for at least 72 hours. After this time, the mites will have died. It is unnecessary to fumigate furniture, pets or carpets.

If you have been diagnosed with scabies, avoid any close and prolonged physical contact with others until you have applied the cream. Also avoid close contact with other household members until their treatment has been completed.

Children and adults can return to school, or work, after the first application of cream has been completed.

Itchiness

Your GP should also be able to prescribe creams, such as a mild steroid creams, that can help to relieve the symptoms of itchiness. Calamine lotion, which is available without a prescription, may also help to relieve itchy skin.

Oral antihistamines can also be used to help control the symptoms of itching, enabling you to get a better night’s sleep. They can be bought at your local pharmacy.

However, oral antihistamines can sometimes cause drowsiness, so avoid driving or operating heavy machinery if you are affected in this way. If you are unsure, check with your GP or pharmacist.

You may continue to experience itchiness for a couple of weeks after your course of treatment has been completed. This is because your immune system will still be reacting to the presence of dead mites and their droppings. You should visit your GP if the symptoms of itchiness persist for longer than six weeks after treatment is complete.

Complementary therapies

There is no evidence to suggest that complementary therapies can effectively treat scabies.