# Scabies infestation - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations, with the dose from MSF Essential Drugs 2024, IVERMECTIN oral: ordinary scabies row: "Child over 15 kg and adult: 200 micrograms/kg single dose. A single dose may be sufficient", with a second dose one week later to reduce the risk of treatment failure. MSF puts that second dose at one week against the 14 days given here, which follows the CDC guideline, and MSF states the same 15 kg floor. · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations · Permethrin 5% w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 15508) · Egyptian National Drug Formulary - Antimicrobial 2023 (ivermectin monograph), Pregnancy and Lactation section · Egyptian National Drug Formulary - Antimicrobial 2023 (benzyl benzoate monograph) - Verified date: 2026-08 ## Verified against - CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations, with the dose from MSF Essential Drugs 2024, IVERMECTIN oral: ordinary scabies row: "Child over 15 kg and adult: 200 micrograms/kg single dose. A single dose may be sufficient", with a second dose one week later to reduce the risk of treatment failure. MSF puts that second dose at one week against the 14 days given here, which follows the CDC guideline, and MSF states the same 15 kg floor. - CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations - Permethrin 5% w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 15508) - Egyptian National Drug Formulary - Antimicrobial 2023 (ivermectin monograph), Pregnancy and Lactation section ## Treatment metadata - Permethrin — topical - Ivermectin — 6 mg — oral.solid - Benzyl benzoate — topical ## Complete treatment card ```text SCABIES INFESTATION Sources: CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations, with the dose from MSF Essential Drugs 2024, IVERMECTIN oral: ordinary scabies row: "Child over 15 kg and adult: 200 micrograms/kg single dose. A single dose may be sufficient", with a second dose one week later to reduce the risk of treatment failure. MSF puts that second dose at one week against the 14 days given here, which follows the CDC guideline, and MSF states the same 15 kg floor. · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations · Permethrin 5% w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 15508) · Egyptian National Drug Formulary - Antimicrobial 2023 (ivermectin monograph), Pregnancy and Lactation section · Egyptian National Drug Formulary - Antimicrobial 2023 (benzyl benzoate monograph) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Itching affecting several household members or close contacts should raise suspicion for scabies [itching] - Some patients have only subtle findings, no known exposure, and lack the classic nighttime itch - Severe itching can disrupt sleep and hurt school or work performance [itching] SIGNS - what you find (7) - A mixed rash of scratched papules, eczema-like or thickened plaques, and nodules is typical [papules · plaques · rash] - Burrows are short wavy white lines ending in a small vesicle or erosion, though often hard to spot [blisters · vesicles] - In children under 2, lesions often involve finger web spaces, wrists, and trunk, and can also affect the scalp, face, palms, and soles - In adults, mites favour skin folds, wrist creases, finger webs, the navel, beltline, nipples, buttocks, and genitals - Weeks of scratching can leave excoriation, crusting, thickened skin, prurigo nodules, and secondary bacterial infection [crusting · itching] - Honey-coloured crusts point to impetigo, while painful red skin suggests cellulitis as a superinfection [cellulitis · redness] - Crusted scabies can cover the hands, feet, palms, soles, scalp, earlobes, and toenails with thick crust [crusting] TESTS (7) - Suspected scabies needs a typical rash pattern plus one supporting history feature - Calling it clinical scabies additionally requires visible burrows - Confirmed scabies needs mites, eggs, or faeces seen on top of the clinical picture - Microscopy of skin scrapings can show mites but is slow and prone to sampling error - Dermoscopy at up to 10x magnification can show burrows resembling a jet-plane contrail - Dermoscopy is limited on dark skin, hairy areas, and the genital region - A skin biopsy can confirm scabies but is not advised as routine practice IF NOT THIS - what else fits (4) - Irritant or contact dermatitis and atopic eczema can coexist with or be mistaken for scabies - Flea, bedbug, or chigger bites should also be considered - Crusted scabies can resemble hyperkeratotic or dyshidrotic eczema, psoriasis, or Darier disease - Bullous scabies must be told apart from lupus erythematosus, bullous impetigo, and pemphigus vulgaris Source StatPearls "Scabies" - disease-level clinical article Status traced to the source above Rx: Main treatment | Topical scabicide when permethrin is unaffordable or unavailable - usable in pregnancy MAIN TREATMENT - choose one 1. PERMETHRIN [1st line] Adult Apply 5% cream over the whole body from the neck down, including neck, palms and soles, and wash off after 8-14 hours; repeat 7-14 days after the first treatment. Up to 30 g (one 30 g tube) per application x 2 applications separated by 7-14 days Peds 2 to 23 months: Whole body including face, ears and scalp, sparing the skin around the mouth and the eyes. Up to 7.5 g. Only under close medical supervision at this age. Repeat in 7 to 14 days. 2 to 5 years: Whole body including neck, palms and soles; the head and face can be spared unless there are lesions there. Up to 7.5 g. Repeat in 7 to 14 days. 6 to 12 years: Whole body including neck, palms and soles; the head and face can be spared unless there are lesions there. Up to 15 g. Repeat in 7 to 14 days. (Where to apply splits at 2 YEARS, not at the minimum age of use. Under 2 years: whole body including face, ears and scalp, sparing the skin around the mouth and the eyes. Over 2 years: whole body including neck, palms and soles - the head and face can be spared unless there are lesions there. Amount: 2 months-5 years up to 7.5 g, 6-12 years up to 15 g. Repeat 7-14 days at every age. Licensed from 2 months, but 2-23 months only under close medical supervision. Patients over 65 should have the face, ears and scalp treated as well.) Source Permethrin 5% w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 15508) Why Gold standard topical scabicide with high cure rate Caution Treat all household and close contacts simultaneously. Wash bed linen and clothing in hot water (>50C). Pruritus may persist for 2-4 weeks post-treatment (does not mean failure). Egypt ECTOMETHRIN 2.5 % CREAM 20 GM MISR > APC (A... 12.00 EGP ECTOMETHRIN 5 % CREAM. 20 GM MISR > APC (A... 21.00 EGP ECTOMETHRIN 5% OINT. 20 GM MISR > APC (A... 21.00 EGP NEWCID 1% 60ML SHAMPOO CID 9.00 EGP NEWCID 1% 80ML SHAMPOO CID 11.00 EGP 2. IVERMECTIN [2nd line] Adult 200 mcg/kg as a single oral dose taken with water; repeat in 14 days x 2 doses separated by 14 days Peds 0.2 mg/kg/dose [child max 15 mg] (200 mcg/kg (=0.2 mg/kg) single dose; safety not established in children < 15 kg) Not for children under 15 kg 15kg -> 3 mg/dose 16kg -> 3.2 mg/dose 17kg -> 3.4 mg/dose 18kg -> 3.6 mg/dose 19kg -> 3.8 mg/dose 20kg -> 4 mg/dose 21kg -> 4.2 mg/dose 22kg -> 4.4 mg/dose 23kg -> 4.6 mg/dose 24kg -> 4.8 mg/dose 25kg -> 5 mg/dose 26kg -> 5.2 mg/dose 27kg -> 5.4 mg/dose 28kg -> 5.6 mg/dose 29kg -> 5.8 mg/dose 30kg -> 6 mg/dose 31kg -> 6.2 mg/dose 32kg -> 6.4 mg/dose 33kg -> 6.6 mg/dose 34kg -> 6.8 mg/dose 35kg -> 7 mg/dose 36kg -> 7.2 mg/dose 37kg -> 7.4 mg/dose 38kg -> 7.6 mg/dose 39kg -> 7.8 mg/dose 40kg -> 8 mg/dose 41kg -> 8.2 mg/dose 42kg -> 8.4 mg/dose 43kg -> 8.6 mg/dose 44kg -> 8.8 mg/dose 45kg -> 9 mg/dose 46kg -> 9.2 mg/dose 47kg -> 9.4 mg/dose 48kg -> 9.6 mg/dose 49kg -> 9.8 mg/dose 50kg -> 10 mg/dose Source CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations, with the dose from MSF Essential Drugs 2024, IVERMECTIN oral: ordinary scabies row: "Child over 15 kg and adult: 200 micrograms/kg single dose. A single dose may be sufficient", with a second dose one week later to reduce the risk of treatment failure. MSF puts that second dose at one week against the 14 days given here, which follows the CDC guideline, and MSF states the same 15 kg floor. Why Oral scabicide for crusted scabies, outbreaks, or topical treatment failure Caution Pregnancy and breastfeeding: not a contraindication. CDC 2021 states ivermectin "likely poses a low risk to pregnant women and is likely compatible with breastfeeding; however, because of limited data ... permethrin is the preferred treatment"; the Egyptian formulary agrees that "use in pregnancy is likely low risk" while other agents are recommended first. Children under 15 kg: CDC 2021 states the safety of ivermectin "for children weighing <15 kg has not been determined" and that infants and young children should be treated with permethrin. Take on an empty stomach with water. Repeat dose in 7-14 days is essential for complete eradication. Egypt IVACTIN 6MG 6 F.C.TABS. DELTA PHARMA 13.50 EGP (2.25/unit) IVERZINE 6MG 24 TABS. UNIPHARMA CO.... 84.00 EGP (3.50/unit) TOPICAL SCABICIDE WHEN PERMETHRIN IS UNAFFORDABLE OR UNAVAILABLE - USABLE IN PREGNANCY 3. BENZYL BENZOATE [2nd line] Adult Apply the 25% lotion at night after bathing, over the whole body from the neck down; let it dry, apply a second coat, and wash it off the next morning. It may be repeated after 24 hours. Peds Same application as adults, but the formulary says to dilute the lotion first: infants, 1 part lotion with 3 parts water; children, 1 part with 1 to 3 parts water. Source Egyptian National Drug Formulary - Antimicrobial 2023 (benzyl benzoate monograph) - verbatim: "Scabies: Topical: After bathing, apply to moist skin and allow to dry, then reapply. Apply at night; bathe and remove the drug the next morning. May repeat application in 24 hours if necessary." Why The card offers permethrin or oral ivermectin only. Benzyl benzoate is the cheap, everywhere-stocked Egyptian scabicide and the article calls it acceptable in pregnancy and in children, which is where permethrin cost or supply most often bites. Caution Do not put it on wounds, burns, broken skin, the face, the eyes or mucous membranes. It stings and burns on application and can cause a contact dermatitis that patients mistake for treatment failure. Dilute it for infants and children, and for elderly patients (1 part lotion with 3 parts water). Wash all bedding and clothing between and after applications, and treat the whole household at the same time. Egypt BENZYL BENZOATE 20% CREAM 40 GM PHAROPHARMA 3.90 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)