Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Oct 15;118(41):695-704.
doi: 10.3238/arztebl.m2021.0296.

Scabies: Epidemiology, Diagnosis, and Treatment

Cord Sunderkötter  1 , Johannes Wohlrab, Henning Hamm
Affiliations
Review

Scabies: Epidemiology, Diagnosis, and Treatment

Cord Sunderkötter et al. Dtsch Arztebl Int. .

Abstract

Background: Scabies is a skin infestation whose incidence is apparently rising.

Methods: This review is based on pertinent articles retrieved by a selective search of PubMed on diagnosis and treatment strategies.

Results: Thread-like papules (burrows), new, intense pruritus, and dermatitis guide the suspected diagnosis which is confirmed by the microscopic or dermatoscopic demonstration of scabies mites. The first line therapy is topical application of permethrin, in accordance with the current recommendations for its use. Other treatment options include systemic ivermectin and topical crotamiton or benzyl benzoate. A combination of permethrin and ivermectin is used to treat otherwise intractable cases and is generally indicated for the treatment of crusted scabies. Known causes of treatment failure include improper application of the external agents, failure of repeated treatment with ivermectin, incomplete decontamination of furnishings and clothes, failure to simultaneously treat contact persons, absence of written documents explaining treatment modalities, and the patient's belonging to a risk group. Even though there has not yet been any direct proof of resistance of scabies mites to permethrin, there is a rising number of welldocumented cases of poor response to this agent. Moxidectin is a new substance now undergoing clinical testing.

Conclusion: Treatment of scabies according to the guidelines and the additional recommendations reported here should result in effective curing, even in cases that are thought to be intractable.

PubMed Disclaimer

Figures

Figure 1
Figure 1
a) clinical and b) dermoscopic findings of a mite burrow, with demonstration of the mite (arrow)
Figure 2
Figure 2
Forest plot for comparing the efficacy of different treatments. Differences in cure rates are shown in a direct comparison of the treatments indicated [95% confidence interval] (modified from [23]).
Figure 3
Figure 3
Forest plot for a comparison of efficacy (cure rates) 1, 2, and 4 weeks after treatment with either topically applied 5% permethrin cream or systemically administered ivermectin 200 µg/kg KG p.o. [95% confidence interval] (modified from [24]). p.o.. per os
See this image and copyright information in PMC

Comment in

  • Clinical Resistance to Therapy.
    Lehmann P, Mang R, Assmann T, Kremer A. Lehmann P, et al. Dtsch Arztebl Int. 2022 Apr 1;119(13):234. doi: 10.3238/arztebl.m2022.0091. Dtsch Arztebl Int. 2022. PMID: 35773994 Free PMC article. No abstract available.
  • In Reply.
    Sunderkötter C. Sunderkötter C. Dtsch Arztebl Int. 2022 Apr 1;119(13):234. doi: 10.3238/arztebl.m2022.0092. Dtsch Arztebl Int. 2022. PMID: 35773995 Free PMC article. No abstract available.

References

    1. Sunderkötter C, Aebischer A, Neufeld M, et al. Increase of scabies in Germany and development of resistant mites? Evidence and consequences. J Dtsch Dermatol Ges. 2019;17:15–23. - PubMed
    1. Nenoff P, Suss A, Schulze I, et al. Skabies-Renaissance einer Ektoparasitose: Diagnostik und Therapie - Vorgehen in der Praxis. Hautarzt. 2021;72:125–136. - PubMed
    1. Boralevi F, Diallo A, Miquel J, et al. Clinical phenotype of scabies by age. Pediatrics. 2014;133:e910–e916. - PubMed
    1. Elsner E, Uhlmann T, Krause S, Hartmann R. Anstieg von Skabies und Therapierefraktärität bei Bundeswehrangehörigen: Acht-Jahre-Follow-up-Studie aus der Hautklinik des Bundeswehrkrankenhauses Berlin (2012-2019) Hautarzt. 2020;71:447–454. - PubMed
    1. Kortas AZ, Polenz J, von Hayek J, et al. Screening for infectious diseases among asylum seekers newly arrived in Germany in 2015: a systematic single-centre analysis. Public Health. 2017;153:1–8. - PubMed