The treatment of choice is 5% permethrin cream. It may be used safely in children and pregnant women. Lindane was once the mainstay of treatment but is now avoided because of the possibility of neurotoxicity. Permethrin cream is applied to the entire body below the chin including under the fingernails and throughout the groin and genital area. The face and neck of children may be treated. The cream is washed off 7-12 hours later and reapplied in one week. Many clinicians will treat everyone in the family if a single person is infested.
Patient’s who are itching after the first treatment can be treated with an inexpensive topical steroid such as triamcinolone cream 0.1.
Consider oral ivermectin for treatment failures, institutionalized patients with extensive involvement and noncompliant patient. It is best to use ivermectin and permethrin at the same time. Ivermectin is given as a single dose and repeated in one week.
The typical outpatient need not take special measures to clean the surroundings except to wash clothing that was recently worn. Facilities with older patients where a number of people are infested will require special measures. Extensive cleaning of rooms, furniture, drapes and rubs is performed. All patient’s and staff should be screened.