Topical scabicides are the treatments of choice. The topical preparation should be applied from the neck down to the feet, with special attention paid to applying the lotion around and under fingernails, in the web spaces of the fingers and toes, and in the umbilicus.

Permethrin 5% cream (Elimite) and lindane 1% lotion (Kwell) are equally effective. Either preparation should be left on overnight and rinsed off the following morning. Lindane is easier to apply and less expensive than permethrin, but lindane resistance has been reported. Furthermore, because of reports of neurotoxicity with the use of lindane in infants, this medication should not be used in children under 6 years of age or in pregnant women. Patients with extensive involvement should be treated again in 1 week.

All household members and sexual contacts at high risk of acquiring scabies should be treated concurrently even if they are asymptomatic, since a delay from the time of infestation to the development of symptoms exists. Nursing homes, institutions, hospital staff, and schools should be notified, and any symptomatic individuals should be treated. Bed linens, towels, and clothing should be washed and dried in a dryer on high heat.

Since pruritus is a common complaint, antihistamines, such as diphenhydramine hydrochloride (Benadryl) or hydroxyzine, should be prescribed as well. A mid-potency topical corticosteroid may also provide relief from itching. In addition, obvious secondary bacterial infection should be treated with an antistaphylococcal agent.

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