How Do You Know If Your Scabies Treatment Worked?
Many Wonder If Their Scabies Treatment Is Working
Many people who receive treatment for scabies feel as though the medication isn't working. This often leads to more anxious trips to the doctor—and the possibility of unnecessary additional treatments using potentially toxic drugs. On top of that, there is the additional cost and stress associated with searching for a true cure.
To mitigate these concerns, it is helpful to understand more about the proper treatment of scabies, and what to expect during the treatment phase.
In this article, I will share the story of my yearlong battle with scabies, followed by a series of confusing and worrisome reactions to the treatment. It is my hope that this information will save others from the anxiety and heartache I experienced.
What Is the Standard Treatment for 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 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. Consult with your physician regarding the proper application of the medicine for you.
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 it 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 the 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.
What Is Post-Scabies Syndrome?
You probably will not experience immediate relief following the first permethrin application because it takes 48-72 hours for the lotion to kill the mites. 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, you are still very likely to experience some itching. This is called post-scabies syndrome, and its cause is currently unknown. People who have this condition 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 affected individuals was biopsied, there was often 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 itself.
As with any prescription drug, permethrin does have potential side effects. Before using it, you should be certain to discuss those side effects with your dermatologist or medical professional. If there is any concern, your doctor may be able to suggest a less-harsh alternative.
Here, my focus is on permethrin because it is currently the standard treatment, and it is what ultimately worked for my family.
What Brought You to This Hub?
Even After I Started Treatment, It Looked Like I Still Had Scabies
My experience was that itchy bumps emerged in random places that were unaffected prior to treatment with permethrin, including on my face, arms, and legs. To my utter distress and confusion, these bumpy rashes were far worse than the original symptoms had been, and they 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 finally went back to normal.
Whatever the cause of post-scabies syndrome, I now know that itchy bumps may continue to emerge for weeks, or even months, following successful treatment. If you talk to dermatologists who have a lot of experience with this condition, or if you read discussion forums online, you will find that many people report that 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 using permethrin.
It is understandably very difficult for a person who has suffered the trauma of an infestation to ignore these newly emerging bumps—and maintain trust in the treatment. However, in my family's case, it was necessary to wait it out for a period of about a month. During that time, the outbreaks became fewer and farther between, and they also became gradually less severe. In the meantime, we found it helpful to use an anti-itching cream such as hydrocortisone, and, less frequently, an antihistamine to calm the body's immune reaction until the symptoms let up. However, again, when using these medications, it is extremely important to first consult with a physician. Hydrocortisone in particular is a steroid, which is associated with its own set of potentially serious side effects.
What If I'm Sure the Treatment Didn't Work?
Of course, it is important to recognize there may be alternative explanations for continued symptoms. Here are some very real possibilities:
- Inadequate coverage of the body with the permethrin cream. For instance, if your doctor told you not to use it on your head, it could leave some mites alive, in which case the entire treatment protocol would have to be repeated.
- Re-infestation 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).
- 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. It is unlikely to occur with just your average Joe who has contracted this condition only once.
- The biting and itching sensations could be due to one of several other mite species that are also 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 I will discuss in another article.
Are There Alternative Treatments?
In addition to permethrin, several other lotions are effective, including benzyl benzoate, sulfur in petrolatum, crotamiton, and lindane. Ivermectin (Stromectol), which is taken orally rather than applied as a lotion, is an anti-parasitic drug that is also effective. Tea tree oil has been shown to kill the mites—but it has not yet been approved for use, which means that it may not be entirely effective, may have undesirable side effects, or may not have been studied thoroughly.
I would beware of the many, many other bizarre treatments you might find online, 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 underlying problem. There are several homeopathic treatments promoted online, but I cannot comment on their effectiveness as I do not have experience with them.
Carey, Elea (medically reviewed by Laura Marusinec, MD). “Scabies Bites: How to Know If You've Been Bit and How to Treat.” June 29, 2016. HealthLine. Retrieved March 27, 2017.
Mayo Clinic Staff. “Scabies.” July 7, 2015. MayoClinic. Retrieved March 27, 2017.
“Scabies.” American Academy of Dermatology. Retrieved March 27, 2017.
More About My Experience:
To hear more about my family's difficult-to-diagnose-and-treat-yet-finally-successful battle with scabies, read my article called Atypical Scabies Symptoms.