What Do Doctors Prescribe for Scabies? A Guide to Treatment

October 8, 2025 •

4 min read

Scabies affects millions of people globally each year, causing intense itching and skin irritation. When diagnosed, a crucial step is understanding what do doctors prescribe for scabies to effectively eliminate the microscopic mites causing the infestation.

Quick Summary

Prescription medications are essential for treating scabies, with options including topical permethrin cream and oral ivermectin tablets. The specific treatment plan depends on individual factors and the severity of the infestation, sometimes requiring combination therapy.

Key Points

Permethrin is First-Line: A 5% permethrin cream is the most common prescription for classical scabies, applied topically from the neck down.
Oral Ivermectin for Special Cases: A tablet, oral ivermectin is used for severe crusted scabies, institutional outbreaks, or when topical treatment fails.
Considerations for Specific Groups: Infants under 2 months, pregnant or breastfeeding women, and young children often require specific or alternative treatments, such as sulfur ointment.
Treat All Contacts: To prevent re-infestation, all household members and close contacts must be treated simultaneously, even if they show no symptoms.
Environmental Cleaning is Crucial: Washing linens in hot water and vacuuming are essential to kill mites and prevent recurrence.
Symptom Relief Can Take Time: Itching may continue for several weeks after successful treatment; adjunctive therapies like antihistamines or topical steroids can help manage symptoms.
Professional Diagnosis is Key: Over-the-counter products are not effective for curing scabies, and a medical diagnosis is required to start proper prescription treatment.

First-Line Scabies Treatments

When a doctor confirms a scabies infestation, they will prescribe a "scabicide"—a medication specifically designed to kill scabies mites and their eggs. The most common and effective first-line treatments are topical permethrin cream and oral ivermectin, which both require a prescription.

Permethrin Cream (5%)

Permethrin 5% cream is widely considered the gold standard for treating scabies, and it is approved for use in individuals as young as 2 months old. It is a synthetic chemical similar to naturally occurring pyrethrins, which are extracts from the chrysanthemum flower.

How to use Permethrin:

Apply the cream to cool, dry skin from the neck down, ensuring all skin surfaces, including the palms, soles, and between the fingers and toes, are covered.
In infants, treatment must also include the hairline, neck, scalp, and forehead.
Leave the cream on for 8 to 14 hours before washing it off thoroughly.
A second application is often recommended a week later to kill any mites that hatched from eggs that survived the initial treatment.

Oral Ivermectin

Oral ivermectin is an antiparasitic tablet that is a systemic alternative to topical scabicides. While it is not FDA-approved specifically for scabies in the US, it is recommended by the World Health Organization and widely used, especially for certain patient groups.

When Ivermectin is prescribed:

It is often used for patients with crusted (Norwegian) scabies, a severe and highly contagious form of the condition.
It may be prescribed during institutional outbreaks where applying topical creams to many people is difficult.
It can be an option for individuals who cannot tolerate or fail to respond to topical treatments.
The typical regimen is two doses (200 µg/kg each), taken 7 to 14 days apart.
Ivermectin is generally not recommended for pregnant or breastfeeding women or children weighing less than 15 kg (33 lbs).

Alternative and Adjunctive Medications

For various reasons, doctors may prescribe alternative scabicides or additional medications to manage symptoms or treat secondary issues.

Topical Alternatives

Sulfur Ointment (5-10%): Compounded sulfur ointment is safe and effective for infants under 2 months old and pregnant women for whom permethrin is contraindicated. It is applied overnight for several consecutive nights.
Crotamiton (10% cream or lotion): While FDA-approved for adults, it is less efficacious than permethrin and is not approved for children.
Benzyl Benzoate: This lotion is another alternative treatment, especially in areas where other medications are less available.
Spinosad (0.9% topical suspension): This is a newer topical treatment for patients 4 years of age and older.
Lindane: Due to potential neurotoxicity risks, Lindane is no longer recommended as a first-line treatment and is restricted or unavailable in many places, including the US.

Medications for Symptom Relief

Even after the mites are killed, the intense itching and rash can persist for several weeks as the body reacts to the dead parasites. A doctor may prescribe or recommend adjunctive therapies to manage these symptoms:

Antihistamines: Oral antihistamines can help control the intense itching.
Steroid Creams: Topical steroid creams can reduce swelling and inflammation associated with the rash.
Antibiotics: If the scratching leads to a secondary bacterial skin infection, oral antibiotics may be necessary.

Comparison of Prescription Scabies Treatments


Treatment	Type	FDA Status (US)	Typical Use	Duration	Considerations
Permethrin 5% Cream	Topical Scabicide	Approved	First-line treatment for classic scabies	Leave on 8-14 hrs; repeat in 1 week	Safe for most, including children >2 months and pregnant/nursing women.
Oral Ivermectin	Oral Antiparasitic	Off-label for scabies	Crusted scabies, institutional outbreaks, or when topical fails	Two doses, 7-14 days apart	Not for pregnant/nursing women or children <15 kg. Take with food for better absorption.
Sulfur Ointment	Topical Scabicide	Compounded	Alternative for infants <2 months and pregnant women	Applied nightly for several nights	Messy with an unpleasant odor.
Crotamiton 10%	Topical Scabicide	Approved (Adults only)	Alternative, but less effective than permethrin	Once daily for 2-5 days	High rate of treatment failure.
Spinosad 0.9%	Topical Scabicide	Approved	For patients 4 years of age and older	Limited efficacy data compared to permethrin	Newer option with less extensive use history.

Treating Special Cases: Crusted Scabies and Family Members

Crusted Scabies

Crusted (Norwegian) scabies is a severe form of infestation characterized by thick crusts containing thousands of mites. It is highly contagious and requires aggressive treatment combining both oral and topical medications. This often involves:

Oral Ivermectin: Given in multiple doses over several weeks, depending on severity.
Topical Permethrin (5% cream): Applied simultaneously and potentially more frequently than with classic scabies.
Keratolytics: These creams, like salicylic acid, help remove the thick crusts, allowing topical medications to penetrate more effectively.

Treating Close Contacts

Scabies is easily spread through direct, prolonged skin-to-skin contact. For treatment to be successful and prevent re-infestation, all household members and close contacts, including asymptomatic individuals, must be treated simultaneously. A doctor will advise on the appropriate medication and protocol for everyone exposed.

Environmental Decontamination

In addition to medication, comprehensive environmental cleaning is necessary to eliminate mites from the home and prevent re-infestation.

Steps for environmental control:

Wash all clothing, bedding, and towels used within the last 72 hours in hot water and dry on a hot cycle.
For items that cannot be washed, seal them in a plastic bag and store them for at least 72 hours to one week.
Vacuum all furniture and carpets, then discard the vacuum bag.

Conclusion

Understanding what do doctors prescribe for scabies is the first step toward effective treatment and recovery. The cornerstone of therapy is prescription medication, primarily permethrin cream or oral ivermectin. The specific choice of medication and treatment plan is individualized and depends on factors like the patient's age, pregnancy status, and the severity of the infestation. It is critical to consult a healthcare provider for an accurate diagnosis and to ensure that all recommended treatment and environmental decontamination steps are followed to achieve a full cure and prevent recurrence. For more information, the Centers for Disease Control and Prevention (CDC) provides detailed guidance on scabies care and prevention.

Frequently Asked Questions

No, there are no approved over-the-counter medications that kill scabies mites or their eggs. Effective treatment requires a prescription from a doctor, typically for a scabicide cream or oral medication.

The mites and eggs are typically killed after one application of a topical cream or two doses of oral ivermectin. However, the intense itching and rash can persist for two to four weeks as the skin reacts to the remains of the mites.

The most common first-line prescription for scabies is 5% permethrin cream, which is highly effective and safe for most people, including children over 2 months and pregnant individuals.

Oral ivermectin is often prescribed for cases of severe crusted scabies, for people who cannot tolerate topical treatments, or during institutional outbreaks where mass treatment is necessary.

Yes, treating all close contacts and household members at the same time is critical to prevent re-infestation, as scabies is highly contagious and can be present without causing symptoms initially.

For infants under 2 months, sulfur ointment in a petrolatum base is often prescribed. Permethrin is approved for infants over 2 months, and treatments for younger babies must be determined by a doctor.

All recently used clothing, bedding, and towels should be washed in hot water and dried on a hot cycle. Items that cannot be washed should be sealed in plastic bags for at least 72 hours, and all carpets and furniture should be vacuumed.

Lindane is not recommended as a first-line therapy due to its potential for serious neurotoxicity, especially in infants, children, and the elderly. Safer alternatives like permethrin are preferred.