How Do You Know if Your Scabies Treatment Worked
What Might Happen After Scabies Treatment
Many people who get treatment for scabies feel as though the medication did not work. This leads to further doctor visits and excess use of potentially toxic drugs over multiple treatments, not to mention the money spent and stress associated with being unable to find a cure.
To lessen this stress and cost, it would be helpful to understand how to properly treat scabies as well as what to expect in the aftermath of treatment.
I am writing this to share my personal story of my year-long battle with misdiagnosed scabies followed by a series of confusing, worrisome reactions to the treatment, in the hopes this information might help someone.
Standard Treatment of Scabies
Currently, the standard treatment for scabies is to apply a 5% permethrin cream to the entire body, including the head, as indicated on the medication label. It is advisable to be absolutely thorough, making sure to cover all skin underneath any hair or nails. In my family's case, it was necessary to apply the lotion to our faces, including just inside the nostrils and on the tops of the eyelids (even at the base of the eyelashes), since these were the locations where the mites were found. Your physician should consult with you on the application of the medicine.
The lotion should be left on overnight. In the morning, all clothes that have been worn by an infested person should be washed, along with that person's bedding and any other surfaces or items that have been touched that can be washed. It is probably not necessary, but would be a good precaution, to clean and vacuum out the car. The individual should then wash the cream off of the body.
This exact routine should be followed a second time one week after the initial treatment, so as to kill any mites hatched from eggs that may have survived the initial treatment. There is no known medication that will kill eggs, so the second treatment is an absolute necessity. All individuals within the household should follow this treatment protocol at the same time, even if they are not experiencing symptoms.
Post Scabies Syndrome: What if the Treatment Didn't Work?
Immediate relief is not typically found following the first permethrin application because it takes 48-72 hours for the lotion to kill the mites. And even after that, the eggs and feces they leave behind in their burrows may continue to irritate the skin until the body absorbs or expels the debris.
You should know that even though your treatment has begun, it is still unlikely to be the end of the itching. The cause of post scabies syndrome is currently unknown, but many scabies sufferers continue to experience scabies-like symptoms long after the mites have been successfully eradicated.
My dermatologist told me that it was once believed these symptoms arose because the body was still trying to expel debris left by the mites. However, when the skin of such affected individuals has been biopsied, there has often been no evidence of any such debris. She said it is now thought that the body may be exhibiting a long-lasting immune reaction, either to the mites and their debris that was once but is no longer there, or possibly to the permethrin treatment.
Because of the potential for side effects when using any prescription drug, one should be certain to discuss how to use permethrin and what its side effects might be with a dermatologist before using it. A medical professional may be able to suggest some less harsh alternatives.
Here, my focus is on permethrin because it is currently the standard treatment, and it is what ultimately worked for my family.
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Even after the Treatment, It Looks like I Still Have Scabies
Whatever the cause, itchy bumps may continue to emerge for weeks or even months following successful treatment of a scabies infestation. If you talk to dermatologists who have a lot of experience with scabies, or if you read scabies forums on the internet, you will find that many people report these outbreaks occur in the very places the scabies' burrows had been prior to treatment. Others report excessive itchiness or twitching in the face after permethrin use.
In my experience, itchy bumps emerged in random places that were unaffected prior to treatment with permethrin, including on my face, arms and legs. These bumpy rashes were far worse than the original symptoms and seemed to be at their worst approximately one week following my second permethrin treatment. They continued to emerge periodically for about three months before everything went back to normal.
It is extremely difficult for a person who has suffered the trauma of an infestation to ignore these bumps and to maintain trust in the treatment. However in my family's case, it was necessary to wait it out and over a period of about a month, the outbreaks became much fewer and farther between as well as less severe. In the meanwhile, we found it helpful to use an anti-itching cream such as hydrocortisone, and sometimes an antihistamine to calm the body's immune reaction until the symptoms let up. However, again, when using these products, it is extremely important to first talk to a physician. Hydrocortisone in particular is a steroid and may therefore have serious adverse side effects.
What if I'm Sure the Scabies Treatment Did Not Work?
Of course, it is important to recognize there may be alternative explanations for continued symptoms.
First, inadequate coverage of the body with the permethrin cream (for instance, if your doctor told you not to use it on your head) could leave some mites alive, in which case the entire treatment protocol would have to be repeated.
Second, reinfestation could occur if clothing and bedding were not properly cleaned, if all members of the household were not properly treated, or if a person continues to come into contact with an infected person, perhaps someone they are dating or working with.
Third, some strains of permethrin-resistant scabies have been reported, however this seems to emerge primarily in populations that have chronic widespread problems with scabies infestations and therefore seems unlikely to occur with just your average Joe who has contracted scabies only once.
Finally, the biting and itching sensations could be from one of several other mite species that are known to affect humans, but that do not actually live and breed on humans, as scabies do. These generally include bird and rodent mites, which will be discussed in another hub.
Are There Alternative Treatments for Scabies?
In addition to permethrin, several other lotions including benzyl benzoate, sulfur in petrolatum, crotamiton, and lindane are effective in killing scabies. Ivermectin (Stromectol) taken orally rather than applied as a lotion, is an anti-parasitic drug that is also effective in killing scabies. Tea tree oil has been shown to kill the mites but it has not yet been approved for use and therefore may not be entirely effective, or may have undesirable side effects.
I would beware of the many many other bizarre treatments reported on the internet as they are likely to be a waste of time, energy, and money. For instance, various bath ingredients may quell the itch but will ultimately do nothing to solve the problem. There are several homeopathic treatments promoted on the internet but I cannot comment on their effectiveness as I do not have experience with them.
Learn More About Scabies
To learn about our difficult-to-diagnose-and-treat-yet-finally-successful battle with scabies, read my article on Atypical Scabies Symptoms.