Treatment and Control of Scabies

Kate E. Mounsey; James S. McCarthy


Curr Opin Infect Dis. 2013;26(2):133-139. 

In This Article

Abstract and Introduction


Purpose of review The treatment of individual patients with scabies and its control in institutional and community settings remains challenging, with relatively few treatment choices available. In this review, evidence of the efficacy of available treatments will be discussed, and possible emerging drug resistance and new therapeutic directions outlined.

Recent findings Although there has been attention on the use of ivermectin for the treatment of ordinary scabies and for mass drug administration, evidence supporting its superiority for both indications over alternative treatment is inconclusive. This is particularly true in light of several case reports of drug resistance in human and veterinary settings when the drug has been intensively used. When used correctly, topical agents such as permethrin and benzyl benzoate are effective. Little research on the development of new and more effective acaricides suitable for human use is underway. While the in-vitro acaricidal properties of several natural products have been documented, these are yet to be evaluated in animal studies or clinical trials.

Summary When properly administered, chemotherapy for scabies remains effective in most situations. However, with reports of drug resistance increasing and with the need for therapies suitable for use in interventions to control community outbreaks, there is a need to develop new therapies.


In the last decade there has been no significant improvement in the availability of treatment for scabies. Instead, there has been a growing body of evidence from clinical studies of the limitations of currently available treatments, as well as ongoing uncertainty regarding the safety of the available treatments. Likewise, the diagnosis of scabies almost universally relies on clinical judgement. In the most recent Cochrane review of treatments for scabies,[1] updated in 2010, weaknesses in study design were highlighted, and the reviewers concluded that there was a paucity in high-quality data on the relative efficacy of available treatments for scabies. Here, we review recent developments in the area, with a focus on the years 2009–2012.