Scabies: how to cure and not infect loved ones

Introduction

Scabies is one of the most uncomfortable and frustrating skin infections a family can face. Caused by the microscopic mite Sarcoptes scabiei, it spreads quickly through close contact, leading to weeks of intense night-time itching, small burrows on the skin, and a restless household. Because it passes so easily between family members, roommates, or classmates, scabies is rarely just an individual problem, it is almost always a shared one. The good news is that scabies is curable. Modern treatments, mainly topical creams such as permethrin and oral medicines such as ivermectin (Stromectol® 3 mg), are highly effective. But treatment alone is not enough. If even one family member or roommate is left untreated, or if bedding and clothing are not handled properly, the mites come back, starting a cycle of reinfestation that can last for months.

That is why successful recovery requires a family plan, not just a prescription. In this guide we present a 7-day home plan: a simple checklist that combines medication with step-by-step instructions for washing, vacuuming, and notifying contacts. With the right coordination, households can break the cycle, stop the itching, and protect loved ones from being infected again.

Symptoms and typical mistakes

The hallmark symptom of scabies is intense itching that worsens at night. This relentless itch comes from the body’s immune reaction to the mite and its eggs. Classic lesions include tiny burrows, often found on the wrists, between the fingers, around the waistline, in the armpits, or on the buttocks. In children, the scalp and soles may also be affected. Scratching can lead to sores, crusting, or even bacterial superinfection. Since itching feels so dramatic, many patients expect it to vanish immediately once treatment is applied. In reality, itching often continues for two to four weeks after therapy. This post-scabetic itch reflects the body’s ongoing inflammation and does not necessarily mean the medicine failed. Misinterpreting this normal reaction leads to one of the most common mistakes: repeating treatment too early or switching unnecessarily between medicines.

Another frequent error is treating only the person with symptoms. Since scabies spreads through skin-to-skin contact, all close contacts like household members, sexual partners, or roommates, must be treated simultaneously. Otherwise, untreated carriers reintroduce the mites, and the cycle continues.

Patients also often overlook the environment. Bedding, towels, and clothing can harbor mites for a short time. Ignoring laundry and cleaning tasks undermines otherwise effective therapy.

Treatment regimens: topical options vs. oral ivermectin (off-label)

The standard treatment for classic scabies remains topical permethrin 5% cream. It is applied from the neck down (including under fingernails and toenails), left on overnight for 8–12 hours, and then washed off. A second application is repeated in 7 days to kill any newly hatched mites. In infants and young children, the scalp is also treated. Permethrin is safe, effective, and widely available.

In some situations, however, topical therapy is impractical. Nursing home residents, individuals with widespread infestation, or families who struggle to apply cream correctly may benefit from oral ivermectin. While not officially licensed for scabies in many countries, the CDC recognizes oral ivermectin as comparable in effectiveness to permethrin.

The usual dose is 200 mcg/kg taken once, followed by a second dose after 7–14 days. Tablets come in 3 mg strength (Stromectol®). Dosing is by weight and then rounded to the nearest whole tablet. For example, a 60-kg adult requires 12 mg (four tablets).

To simplify dosing, families can use a Stromectol dosage table prepared by their doctor. For instance:

• 30–39 kg → 2 tablets (6 mg)
• 40–59 kg → 3 tablets (9 mg)
• 60–79 kg → 4 tablets (12 mg)
• 80–99 kg → 5 tablets (15 mg)
• ≥100 kg → 6 tablets (18 mg)

No matter which option is chosen, all close contacts must be treated at the same time. Treating only the symptomatic person is a recipe for relapse. A coordinated household plan (medication plus linen care) offers the best chance of breaking the cycle.

When a second dose of ivermectin is needed; who is not suitable

One tablet course of ivermectin is not enough to cure scabies. The medicine kills the mites, but it does not affect eggs already laid in the skin. Within a week, those eggs hatch. If a second dose is not taken, the new mites will restart the infestation. This is why a repeat dose 7–14 days later is always recommended. Families should treat everyone again on the same day to keep results synchronized. Read more about Ivermectin protocols for human

A second dose is especially important in severe infestations, institutional outbreaks, or when itching continues beyond two weeks. In these cases, missing the follow-up means the mites regain their foothold, undoing the progress of the first round.

Not everyone is suitable for ivermectin. The drug is generally avoided in pregnant or breastfeeding women because of limited safety data. For children under 15 kg, ivermectin is not recommended; instead, permethrin cream is preferred. Patients in regions where Loa loa is present require careful evaluation, since ivermectin can cause severe reactions in those with heavy Loa loa infection.

Family tip: Mark both treatment days on the laundry & cleaning chart or a wall calendar. This prevents confusion, ensures nobody skips the second round, and keeps the whole household on track.

In short, scabies is beaten not with one treatment, but with two well-timed doses plus family-wide coordination.

Home disinfection, contacts, group

Killing the mites on the skin is only half the battle. They can live up to three days on clothes, bedding, or towels, so environmental cleaning is crucial.

The rule is simple: wash hot, bag what you can’t wash, and vacuum daily. Clothes, pajamas, sheets, and towels should be washed at ≥60 °C and dried on high heat. Items that cannot be washed (sweaters, soft toys, shoes) should be sealed in plastic bags for 72 hours. Mites die without a host in that time. Furniture, mattresses, and carpets need thorough vacuuming. A laundry & cleaning chart helps families tick off what has been washed or bagged, so nothing is missed.

Equally important is treating all contacts simultaneously. Even those without itching can carry mites. Everyone in the home, plus close partners or babysitters, should follow the same schedule.

In kindergartens, dorms, or nursing homes, a single case may require coordinated action. Notifying administrators allows group treatment to prevent reinfection. A template message for schools or roommates can simplify this step and reduce stigma.

FAQ

Why does itching continue after treatment?

Itching may last 2–4 weeks even after mites are killed, due to skin inflammation. This is normal and not a sign of failure.

Can I go to the pool or gym?

Wait until the first treatment is complete before returning, to avoid spreading mites.

What should pregnant women do?

Permethrin cream is preferred. Ivermectin is not recommended during pregnancy or breastfeeding.

What about children under 15 kg?

Use topical permethrin. Oral ivermectin should be avoided in this group.

Do pets spread scabies?

No. Dogs and cats carry different mites that do not survive long on humans.

What if I miss the second dose of ivermectin?

Take it as soon as you remember. If much time has passed, repeat a full two-dose course, treating the whole family together.

Conclusion

Scabies is not just a skin rash, it is a family problem that requires a coordinated solution. Successful treatment depends on three steps: the right medicine, strict timing of doses, and thorough attention to clothing, bedding, and contacts. Permethrin cream remains the standard, while ivermectin (Stromectol® 3 mg) is a safe, effective off-label option for adults and older children, provided that two doses are taken.

The 7-day home plan, supported by a laundry chart and shared calendar, helps families stay organized and prevents reinfection. Treating only one person or skipping environmental cleaning almost guarantees the mites will come back.

With good coordination, scabies can be cleared quickly, and the cycle of itching and sleepless nights can finally be broken. The key is simple: treat the person, treat the family, treat the home.

References

1. Centers for Disease Control and Prevention. (2024). Clinical care of scabies. U.S. Department of Health & Human Services. Retrieved from https://www.cdc.gov/scabies/hcp/clinical-care/index.html
2. Chosidow, O. (2006). Clinical practices: Scabies. New England Journal of Medicine, 354(16), 1718–1727. https://doi.org/10.1056/NEJMcp052784
3. Strong, M., & Johnstone, P. (2007). Interventions for treating scabies. Cochrane Database of Systematic Reviews, 2007(3), CD000320. https://doi.org/10.1002/14651858.CD000320.pub2