Which cream is best for scabies? A Guide to Effective Topical Treatments

October 11, 2025 •

4 min read

Worldwide, it is estimated that hundreds of millions of people are infested with scabies at any given time. When faced with this intensely itchy parasitic infection, patients often ask, which cream is best for scabies? The answer generally points to permethrin 5% cream, but other options and factors must also be considered for successful treatment.

Quick Summary

A comprehensive overview of topical treatments for scabies, comparing different creams based on effectiveness, safety, and specific patient needs. It covers the application process, side effects, and environmental control measures to prevent re-infestation.

Key Points

Permethrin 5% Cream: Widely considered the first-line and most effective topical treatment for typical scabies infestations.
Safe for Most Ages: Permethrin 5% is generally safe and FDA-approved for adults, pregnant women, and children over 2 months of age.
Application Method: The cream should be applied from the neck down (including the scalp for infants and the elderly) and left on for 8-14 hours before washing off.
Other Topical Options: Alternatives like sulfur ointment are available, especially for infants under 2 months, though they can be messy and odorous.
Combined Treatment for Crusted Scabies: Severe cases, known as crusted scabies, often require a combination of topical cream and oral ivermectin.
Environmental Cleaning is Crucial: Successful treatment depends on simultaneously decontaminating clothing, bedding, and furniture to kill mites and prevent re-infestation.
Post-Treatment Itching is Normal: Itching may persist for several weeks after successful treatment, and does not automatically mean treatment failure.

Understanding Scabies and the Need for Treatment

Scabies is a contagious skin infestation caused by the Sarcoptes scabiei mite. These microscopic mites burrow into the outer layers of the skin, where the female lays eggs. This causes an intense, persistent itch, often worse at night, and a characteristic rash of small bumps or blisters. Because scabies spreads easily through direct, prolonged skin-to-skin contact, treating everyone in a household and any sexual contacts is critical, even if they show no symptoms. Effective treatment involves not only killing the mites and eggs on the body but also decontaminating the environment.

Permethrin 5% Cream: The Gold Standard

For most cases of typical scabies, permethrin 5% cream is the first-line treatment recommended by the Centers for Disease Control and Prevention (CDC). Its effectiveness is widely supported by clinical evidence.

How Permethrin Works

Permethrin is a topical cream containing a synthetic insecticide that paralyzes and kills scabies mites and their eggs. Its low absorption through the skin makes it a safe and highly effective option for most people.

Proper Application and Dosage

For adults and children over 2 months: Apply a thin layer of the cream to all skin surfaces from the neck down, paying close attention to areas between the fingers and toes, under the fingernails, wrists, elbows, and groin.
For infants and the elderly: The cream should also be applied to the scalp, face, and neck, while carefully avoiding the eyes, nose, and mouth.
Leave on time: The cream should be left on for 8 to 14 hours, typically overnight, before being washed off.
Repeat application: A second application is often recommended one week later to kill any mites that have hatched from eggs since the initial treatment.

Considerations for Permethrin

Safety: It is considered safe for use in pregnant and breastfeeding women, as well as children over 2 months.
Side Effects: Mild, transient burning, stinging, itching, and redness can occur at the application site. Persistent itching for several weeks post-treatment is common and does not necessarily indicate treatment failure.

Alternative Topical Treatments

While permethrin is the top choice, several other topical treatments are available, particularly for patients who cannot tolerate or don't respond to permethrin, or for specific age groups.

Sulfur Ointment

Use for infants: A 5-10% sulfur ointment is a safe alternative for infants under 2 months, for whom permethrin is not approved.
Disadvantages: This treatment requires daily application for several consecutive nights and is often messy and unpleasant due to its odor.

Crotamiton Cream/Lotion

Effectiveness: Crotamiton 10% is FDA-approved for adults but has a higher treatment failure rate and is less effective than permethrin.
Drawbacks: It is not recommended for use in children.

Benzyl Benzoate

Regional Use: This is used as an alternative treatment, particularly in developing countries.
Pregnancy/Infants: Diluted versions are sometimes used for pregnant women and infants.

Crusted Scabies and Oral Treatment

Crusted scabies, a more severe and highly contagious form of infestation, requires more intensive treatment, often combining topical and oral medications. Oral ivermectin is frequently prescribed in these cases, sometimes in combination with topical permethrin. Ivermectin is not recommended for pregnant or breastfeeding women or for children weighing less than 15kg.

Comparison of Topical Scabies Treatments


Feature	Permethrin 5% Cream	Sulfur Ointment 5-10%	Crotamiton 10% Cream	Benzyl Benzoate Lotion	Oral Ivermectin (used in severe cases with cream)
Efficacy	Excellent (First-line standard)	Variable, generally effective	Lower efficacy, higher failure rate	Variable, widely used outside the US	Very effective, especially for crusted scabies
Typical Application	One application for 8-14 hours, repeated in one week	Applied nightly for 3-5 consecutive nights	Two applications, 24 hours apart	Varies based on concentration and patient age	Oral tablet, specific dosing interval
Key Advantages	Highly effective, well-tolerated, low systemic absorption	Can be used for infants under 2 months, pregnancy	FDA-approved for adults	Effective alternative, especially in resource-limited areas	Ease of administration, useful for institutional outbreaks
Key Disadvantages	Prescription required, mild skin irritation possible	Unpleasant odor, messy, requires compounding	Higher failure rate, not for children	Lower evidence base, potential irritation	Not for infants, pregnant/breastfeeding women; prescription needed

Environmental Cleaning is Essential

Treatment of the human host is only half the battle. Scabies mites can survive for several days off the skin, so thorough environmental decontamination is necessary to prevent re-infestation.

Steps for environmental control:

Launder All Items: Wash all clothing, towels, and bedding used in the last 72 hours in hot water (at least 60°C/122°F) and dry on high heat.
Seal Non-Washable Items: For items that cannot be washed, such as stuffed animals or coats, seal them in a plastic bag for at least three days.
Vacuum Thoroughly: Vacuum carpets, rugs, and upholstered furniture. Dispose of the vacuum bag immediately after use.
Consider Dry Cleaning: If you have items that need dry cleaning, take them in after treatment begins.

Conclusion

For most individuals seeking to treat scabies, the answer to which cream is best for scabies is permethrin 5% cream. Its high efficacy and favorable safety profile make it the recommended first-line treatment. However, other options like sulfur ointment are important for special populations such as infants under two months. In all cases, successful eradication requires not only proper application of medication but also meticulous environmental decontamination to prevent re-infestation. Always consult a healthcare provider for a proper diagnosis and treatment plan to ensure the best outcome. For further reading on scabies, consult reliable medical resources such as the Centers for Disease Control and Prevention (CDC).

Frequently Asked Questions

In the United States, there are no approved over-the-counter products that effectively kill scabies mites and their eggs. A prescription-strength cream, such as permethrin 5%, is necessary for a cure.

Permethrin 5% cream is FDA-approved and generally considered safe for children who are at least 2 months old. For infants under 2 months, a doctor will likely prescribe a safer alternative, such as a 5-10% sulfur ointment.

Itching can persist for several weeks after successful treatment because it is a reaction to the dead mites and their remnants in the skin. This does not necessarily mean the treatment failed, but you should contact your doctor if intense itching lasts for more than four weeks or if new lesions appear.

Yes, because scabies spreads easily through skin-to-skin contact, all household members and close contacts should be treated at the same time, even if they show no symptoms, to prevent re-infestation.

Permethrin is a topical cream and the standard first-line treatment for most scabies cases. Ivermectin is an oral tablet reserved for severe or widespread infestations, such as crusted scabies, or when topical treatment is unsuccessful. Ivermectin also has different safety considerations, especially for children and pregnant women.

All clothing, bedding, and towels used in the last 72 hours should be washed in hot water (at least 60°C) and dried on a hot setting. Non-washable items can be sealed in a plastic bag for at least three days.

While some natural oils like tea tree oil or neem oil have been studied for their antimicrobial properties, there is limited scientific evidence to prove they can cure a full-blown scabies infestation. Relying solely on these is not recommended and can lead to continued spread.