Scabies is a highly contagious skin infestation caused by the microscopic mite Sarcoptes scabiei, which burrows into the skin to lay eggs. This causes intense itching and a rash, and is a significant public health concern. In Saudi Arabia, the treatment protocol involves a combination of medication and thorough environmental decontamination to prevent re-infestation. The most common and effective prescription medicine is a topical cream, but oral alternatives are also used for certain cases.
The Primary Treatment: Permethrin 5% Cream
The most widely recommended and effective treatment for scabies in Saudi Arabia, and globally, is 5% permethrin cream. It is a potent topical scabicide belonging to the pyrethroid class of medications. Permethrin works by disrupting the mites' nervous system, causing paralysis and death. It is also ovicidal, meaning it kills the mites' eggs, which is essential for preventing a recurrence of the infestation.
Brands such as Eralyce, containing 5% permethrin, are available by prescription in Saudi pharmacies like Nahdi and Lemon.sa. The medication is generally considered safe and effective for use in adults and children over two months of age. Mild side effects such as a temporary increase in itching or burning sensation can occur, but these are typically self-limiting.
How to Use Permethrin Cream Effectively
Correct application is vital for successful treatment. Following these steps, as recommended by healthcare professionals, ensures maximum efficacy:
- Take a bath or shower and dry your skin thoroughly before application.
- Massage a thin layer of the cream over your entire body, from the neck down to the soles of your feet. Pay close attention to areas like the spaces between fingers and toes, underarms, and genitals. For infants and the elderly, the hairline, neck, and scalp should also be treated.
- Leave the cream on the skin for 8 to 14 hours. It is often recommended to apply it before bed and wash it off in the morning.
- After the required time, wash off the cream completely with soap and water.
- Repeat the application one week later, following the same procedure. The second application is crucial for killing any mites that may have hatched from eggs that survived the first treatment.
Alternative and Oral Medications
While permethrin is the standard, other medications are sometimes used for specific patient populations or in more complicated cases.
Oral Ivermectin
Oral ivermectin is an anthelmintic agent that can be used to treat scabies, especially in severe or widespread cases like crusted scabies, or during outbreaks in institutional settings. It is a prescription-only medication and is not typically recommended for pregnant or breastfeeding women or children weighing less than 15 kg. A single oral dose may be administered, often followed by a second dose one to two weeks later. Some studies have shown it to be as effective as topical permethrin.
Sulfur Preparations
Topical sulfur preparations, such as a 6–10% sulfur in petrolatum ointment, are an older treatment option. They are considered safe for infants under two months of age and pregnant women, who cannot use permethrin. However, sulfur is less effective than permethrin, has a strong odor, and can be messy and irritating to the skin. It requires daily application for several consecutive days, and its use is less common today due to better alternatives.
The Importance of Environmental Decontamination
Medication alone is insufficient to eliminate scabies. The mites can survive off a human host for a few days, necessitating a thorough cleaning of the environment to prevent re-infestation.
Decontamination Steps
- Wash Fabrics: All clothing, bedding, and towels used by infested individuals in the 72 hours before treatment should be washed in hot, soapy water (at least 60°C) and dried on high heat.
- Seal Items: Items that cannot be washed, such as stuffed animals or furniture covers, should be sealed in a plastic bag for at least 72 hours.
- Clean Furniture: Vacuum carpets, rugs, and upholstered furniture. In institutional settings, mattresses and upholstered furniture may be gently ironed with a hot iron to kill any mites.
Comparison of Scabies Treatments in Saudi Arabia
| Feature | 5% Permethrin Cream | Oral Ivermectin | 6-10% Sulfur Cream |
|---|---|---|---|
| Type | Topical Scabicide | Oral Anthelmintic | Topical Scabicide |
| Mechanism | Paralyzes mites and eggs | Paralyzes mites | Antimicrobial and scabicidal properties |
| Efficacy | 86–100% | 76–100% (varies) | 39–100% (varies) |
| Use Cases | Standard treatment for most cases | Crusted scabies, outbreaks, when topical fails | Infants <2 months, pregnant women |
| Safety | Considered safe for most over 2 months | Not for <15kg, pregnant, or breastfeeding | Safe for infants, pregnant women |
| Application | Single application, repeat one week later | One or two doses, taken with food | Daily application for several days |
| Side Effects | Mild burning, itching, irritation | Nausea, rash, dizziness, itching | Messy, strong odor, skin irritation |
Post-Treatment Care and Itch Management
It is important to remember that itching often persists for several weeks even after successful eradication of the mites. This is due to the body's allergic reaction to dead mites and their remnants under the skin. Continued itching does not necessarily mean the treatment failed. Healthcare providers may recommend soothing measures to manage this post-treatment itch, including cool compresses, antihistamines, or topical steroids. However, patients should avoid confusing this post-treatment symptom with a new infestation, which would require a doctor's reassessment.
Conclusion
The primary medication for scabies in Saudi Arabia is 5% permethrin cream, a highly effective topical treatment available by prescription. For more complex cases, oral ivermectin may be used. The Saudi Ministry of Health emphasizes that medication must be paired with rigorous environmental decontamination and the simultaneous treatment of all close contacts to prevent re-infestation. Over-the-counter creams with lower concentrations of permethrin are ineffective against scabies and should not be used. Consulting a doctor for a proper diagnosis and treatment plan is the best course of action. Following the correct application procedures and decontamination steps is the most effective way to eliminate the infestation and find relief.
Authoritative Outbound Link
For more information on scabies and prevention strategies from a leading global health authority, visit the World Health Organization's page on scabies: https://www.who.int/news-room/fact-sheets/detail/scabies.
