• Scabies, a mite infestation is contagious and spreads within a family, school or nursing home.
  • Clinical features include intense itch, especially at night, burrows and a non-specific excoriated eruption especially in web spaces of hands, genitalia, buttocks and areola of the breasts.
  • Atypical presentation including head/neck, palms and soles may be seen in young children and immunocompromised.
  • Consider in high risk occupations e.g. nursing.
  • Crusted scabies in the elderly/immunocompromised may be mistaken for dermatitis or psoriasis and itch may be less prominent.


  • Patients with scabies should generally be managed in Primary Care
  • Treat all household members and other contacts whether symptomatic or not
  • Treat from the neck down (head and neck should be treated in the immunocompromised, children under 2 years and the elderly)
  • Permethrin 5% Dermal Cream should be applied all over and left on for 8 hours
  • Malathion aqueous lotion left on for 24 hours
  • Reapply treatments to hands on washing
  • Repeat any treatments in 7 days
  • Advise patients to change and wash all bed linen, clothes/underwear

Dermatology Referral Criteria

  • Diagnostic uncertainty
  • Crusted (Norwegian) scabies
Therapeutic Tips
  • Itching may last for 2-4 weeks following successful treatment.
  • Crusted scabies is highly infectious, therefore isolate patient.
  • Involve public and environmental health staff if outbreak is in hospital, nursing or residential home, school, nursery or other group setting. Consult local guidelines.
  • Urea or crotamiton containing emollients twice daily may provide additional symptomatic relief.
Patient Information