Scabies Treatment: Permethrin & Ivermectin

Scabies is treated with a prescription scabicide. The standard choice is permethrin 5% cream applied over the whole body from the neck down and washed off after 8–14 hours; oral ivermectin is an alternative CDC treatment. Treat all close contacts at once, decontaminate bedding and clothing, and expect itching to linger for weeks even after the mites are dead.

How scabies is treated

Scabies is caused by the human itch mite Sarcoptes scabiei, a microscopic parasite that burrows into the upper layer of skin to live and lay eggs CDC, About Scabies. The intense itch isn't the mite biting you — it's an allergic reaction to the mites, their eggs, and their waste in the burrows. Killing them requires a prescription scabicide; over-the-counter anti-itch products don't eradicate the infestation.

First-line treatment is permethrin 5% cream. You apply a thin layer over the entire body from the neck down — including the soles of the feet, between fingers and toes, the navel, the groin, and under the nails — and leave it on for 8–14 hours before washing off CDC STI Tx Guidelines. Because mites can survive eggs that hatch after the first application, a second application about a week later is standard practice.

Oral ivermectin is the alternative, dosed at 200 µg/kg by mouth and repeated in 14 days. It's useful when a cream is impractical, when many people need treating at once, or for severe cases. The repeat dose matters because ivermectin kills hatched mites but is less reliable against unhatched eggs, so the second dose catches the next generation.

Crusted (Norwegian) scabies

Crusted scabies is a severe, extremely contagious form in which the skin carries up to about two million mites instead of the small number seen in ordinary scabies CDC clinical overview. It develops in people who can't mount a normal immune response or itch — the elderly and the immunocompromised, including those with advanced HIV. It usually needs combined treatment with both topical permethrin and oral ivermectin under medical supervision, plus aggressive contact tracing because shed skin flakes alone can spread it.

What scabies treatment is actually like

The cream is unglamorous but straightforward. Apply it to cool, dry skin — not right after a hot shower, which opens pores and increases absorption — and reapply to your hands every time you wash them during the treatment window. Sleep in it overnight, then shower it off in the morning. Many people find one missed area (commonly the back, the nails, or behind the ears) is why they don't fully clear, so enlist help reaching everywhere.

The hardest part to accept is that itching can persist for two to four weeks after successful treatment. This post-scabetic itch is the lingering immune reaction to dead mites and their debris breaking down in your skin — it does not mean the medicine failed. A clinician may recommend an antihistamine or a topical steroid to manage it. Resist the urge to re-treat repeatedly on itch alone, since overusing permethrin irritates skin and feeds the cycle.

Finish the full course, including the repeat dose, even once you feel better — and ask whether your partner needs treating so you don't pass it back and forth. A diagnosis here is common and treatable; clinics handle it routinely, and it says nothing about you as a person. If scratching has broken the skin, watch for signs of secondary bacterial infection, which can complicate untreated or heavily scratched scabies.

Partner and household treatment

Treat everyone in the same household and all sexual or close contacts from the past month at the same time, whether or not they itch yet. Mites spread by prolonged skin-to-skin contact, and a newly infected person can be contagious before symptoms appear — treating only the person with the rash almost guarantees reinfection. Avoid skin-to-skin contact until everyone has been treated.

Decontaminate the environment on treatment day. Machine wash bedding, towels, and recently worn clothing in hot water and dry on high heat; items that can't be washed can be sealed in a plastic bag and kept away from skin for 72 hours, since mites off a human host die within a few days. You don't need to fumigate the house or replace furniture — that's a common, costly overreaction.

For the bigger picture on breaking the cycle, see our guide to preventing scabies reinfection.

Follow-up: is there a test-of-cure?

There's no routine lab test-of-cure for scabies. Success is judged clinically: no new burrows or lesions and gradually settling itch over the weeks following treatment. New burrows or fresh papules appearing after the treatment window suggest either reinfection from an untreated contact or treatment failure, and that warrants going back to your clinician.

Because scabies in adults is often sexually transmitted, a diagnosis is a good prompt to check for other infections that travel the same way. Many STIs have no symptoms, so even if you feel fine it's worth knowing when to test after exposure and choosing to get tested. Most STI testing is a simple urine cup, a self-collected swab, or a quick exam, with results usually back in a few days, and it's free or low-cost at health departments, Planned Parenthood, and Title X clinics.

What happens if scabies goes untreated

Scabies doesn't clear on its own. Left untreated, the mites keep reproducing and the itch worsens, especially at night. Persistent scratching breaks the skin and opens the door to secondary bacterial infection — impetigo or deeper soft-tissue infection — which can require antibiotics. An untreated person also keeps infecting everyone they're in close contact with.

In someone whose immune system is compromised, ordinary scabies can progress to the crusted form, with its enormous mite burden and high contagiousness. That's one reason prompt treatment matters not just for comfort but to protect vulnerable household members.

Preventing scabies going forward

Prevention comes down to avoiding prolonged skin-to-skin contact with an infested person until they're treated, and treating all contacts together so no one reseeds the household. For the sexually transmitted route, condoms used every time lower risk for many infections, though they don't fully prevent scabies because the mite spreads through broad skin contact, not just genital contact.

Routine STI testing catches infections that have no symptoms before they spread. If you're choosing where to go, you can compare testing providers on cost, privacy, and turnaround.

When to see a clinician

• You have an unexplained, intensely itchy rash — especially worse at night or with thin gray burrow lines in the finger webs, wrists, or genitals — that needs a diagnosis and a prescription.
• You're not sure whether it's scabies, since the rash overlaps with other conditions; our guide to scabies vs bed bugs vs eczema can help you tell them apart before your visit.
• New burrows or lesions appear after you've completed treatment, suggesting reinfection or treatment failure.
• The skin becomes red, warm, swollen, weeping, or crusted, which can signal a secondary bacterial infection.
• You're pregnant, breastfeeding, treating a young child, or immunocompromised, since drug choice and dosing need individualizing.