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How Do You Know If Your Scabies Treatment Worked?

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Scabies

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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 year-long 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.

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:

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  1. 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.
  2. 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).
  3. 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.
  4. 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 due to lack of personal experience with said items.

Learn More

General References:

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.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Comments

Kundan on October 17, 2019:

Hello everybody. I am on my 4th week after my 3rd permethrin treatment (treated thrice with one week intervals from scalp down ). Is it normal that i am getting itchy red bumps on my fingers after treatment? I never had scabies on or between my fingers. But after treatment i am getting itchy red bumps on or between my fingers too ! Is it normal ? Any input will be greatly appreciated.

Tina on October 03, 2019:

Hello,

Since this article helped me through my scabies infection journey, I am writing here to help others. I am on week 9th after second treatment and I am pretty sure I am healed. However, by 2 weeks ago I was not sure yet! I mean the post scabies symptoms are real, serious, and long lasting. I have applied permethrin 5% twice, one week apart from neck down. I cleaned my house by washing the cloths, bedding, towels, and vacuuming mattresses, coaches and carpets. That's it. It was enough for me and my family treatment. However, post scabies itchy pimples used to pop up till 7 weeks after the second treatment. Reading this article helped me bear these 7 stressful weeks and not putting more expensive and toxic pertmethrin on my body. Thanks.

Jonah Goldstein on June 27, 2019:

Hello everyone,

I’m dealing with scabies, I’ve had them for around 3 months (one knowingly). I did my 4th pemethrin treatment a couple days ago along with my 2nd ivermectin treatment. I’m currently staying in a place away from my apartment where I got infested. I took nu stock ointment last night with lotion and kept it on all night. I want to do an intense regiment while I’m away from my apartment so I can fully eradicate these bastards and go back to a normal life. My question is I’ve noticed after the 6th day of applying the permethrin I start to break out again with lines and bumps. On my last treatment should I do the permethrin on the 3rd or 4th day rather then the 7th?? Lemme know y’all, thanks. Btw this has been the most annoying experience of my life, we need to come up with a vaccination against these bastards!

Alex on June 03, 2019:

I want to tell my story with Scabies.

About 3 months ago, I started to itch like crazy. Had long sprawling track lines on my wrist + side of hands. Inner thighs were itching like mad. Wrists were almost bleeding that the rash got so bad!

Went to the doctors and she prescribed two causes of Permethrin. From treatment 1 to 4-weeks later, it largely subsided. During this time, new rashes and bumps would appear. Bizarrely the track lines would continue to get longer even after apply the permethrin.

4 weeks after the first treatment (2 weeks after the second treatment) , the rash re-appeared between my knuckles (after touching my girlfriend again). I could tell that this wasn't just a post-scabies rash as it was pretty material and so I returned to the doctors. She gave me another 2 sets of treatment of permethrin + hydrocortisone this time. The latter has been fantastic at reducing all those red bumps / marks that might just be a post-scabies rash that you allude to in your article.

It's now gone down largely. 2 days after my second treatment (ie today) (4th in total) I had a few red bumps and acne-like pus-stool appear on my finger again. I've applied the hydrocortisone which has actually reduced the size of these marks.

I'd like to think that this is just a post-scabies reaction (especially after having used permetrhin so much). There aren't any track-lines like in the beggining and the hydrocortisone pretty much quashes the red marks down to a tiny bump. I'll detox from the permethrin for a few weeks now, unless it flares up massively.

This page has been the one page that has actually helped me through this. Now when a new mark appears I don't freak out, and I keep a cool head. From 3 months ago to now, it's definitely improved.

Some things I'd add. I've been reading quite a few scientific papers on scabies which has helped my understanding a lot. I didn't take note of them as I read so can't source, but here are some of the findings I found useful:

* In a study on around 25 people on the effectiveness of treatment, around 75% of people are cured first-time with permethrin. After the second treatment, 100% of people were treated. For cromatronin (eurax), this was 65% in the first treatment, and 100% in the second.

* Once you have had scabies, your body has an increased sensitivity, especially to dust mites which are non-harmless. Try to reduce all dust in your house, as those red marks might actually just be a reaction to something else.

* Eat healthily and take vitamin tablets during the process. Paitents with a low immunity get crusted scabies, and have 500+ mites on their body. Theoretically, all scabies paitents should have this much due to the amount of eggs each mite lays. But the role of your immunity reduces this down to around 5-12 mites on an average person. I'm connecting the dots a little here, but I'm presuming the healthier you are therefore, the more likely your body is to resist these things. I also foudn when I took mineral tablets (berocca), it helped my skin grow back where those track line scars were + reduced itching since its an anti-hysteramine.

* Lastly, permethrin is actually able to kill eggs. I believe the conflicting information online about this is due to the stages of the larvae. I presuming it can kills eggs at a certain level of development, but not larvae that was layed immediately before you applied the first treatment (hence why 2 doses is recommended).

Kate M on May 27, 2019:

Thanks! I am teacher and that was my first thought, but the dr made made it seem like that wasn’t the case. I just didn’t notice any of my students ITCHING like I was and I’m normally on top of that! They scratch their head and I’m in the nurses office with them kind of person. So I was just confused where else I could have picked it up from. I don’t like the dr I saw so I’m in process of finding a new dr. The dr seemed like he was too busy for my questions and even when I tried call with questions I thought of afterwards it was hassle to get a hold of them. I have been uses Benadryl anti-itch cream for the random urges. I was just curious of maybe other options. Thank you again!

Samoa6 (author) from San Diego on May 27, 2019:

Hi Kate - you don't have to be in contact that long, you just have to be kind of unlucky! You could get it from picking up a child who has it, possibly from daycare or a camp, or from an elderly person you may have been helping. Could be anything. I can't remember what the best thing for itching is, maybe anti-histamines, but you should ask a doctor. Definitely don't keep spot treating though, the permethrin is poisonous stuff.

Kate M on May 27, 2019:

Hello, I was diagnosed with Scabies about a month ago. I’m definitely dealing with post Scabies syndrome. I have two questions 1) what did you find worked best for the itching? It is starting to decline but just once in awhile I get a terrible itch sensation and obviously try not to scratch but sometimes it’s a reflex and I can’t help it. 2) I was so confused when the Dr told me I had scabies. I asked how I could have gotten it and he really didn’t give a great answer. So of course I had to search online. It sounds like you had to have a long exposure to someone who has had it. However, I never noticed anyone I’m in contact with on a regular basis itch like I did, nor am I sexually active. So how else could I have gotten it? Any ideas? I want to be able to avoid how I got it in the first place. Thank you in advance for any answers.

Ruby on May 05, 2019:

Mine was finally diagnosed as Lichen planus.

Not even scabies after all.

Samoa6 (author) from San Diego on May 04, 2019:

Hi Sam,

No, they can't live off of you, but they will try, i.e., they will bite for a while and then die. The only concern you should have is that if you brought a few in your clothes or bedding, and there happens to be a rodent problem at your new place, they could find their way onto another host and begin to thrive again. But this scenario seems unlikely. Odds are your problem is solved.

sam on May 03, 2019:

that would make perfect sense. My apartment complex is very old. Back in November I woke up to a rat in my pantry and immediately had maintenance come look for and patch up holes. I never saw another one in my apartment but I continued to hear them run around in the ceiling. Since this post I've moved out of the apartment taking very very little with me and cleaning it thoroughly. No furniture. Do you know if these things can live on humans? I'm scared to have taken them to where I'm staying now despite having what little things I took with me cleaned. I haven't seen any mites since moving but I'm just concerned about having to deal with this all over again if a few of them managed to move with me

Samoa6 (author) from San Diego on April 29, 2019:

Hi Sam - if you can see them without a microscope, they are probably bird or rodent mites coming from somewhere in your attic or under your house. this happens often if a nest has been abandoned due to painting or some other disruption, i.e., you probably had some sort of animal living in or around your house that recently left, leaving the mites with no food so they follow the CO2 and find you. these guys are transparent until they've eaten blood, after which they look dark red/brown/black. have a pest control person take a look.

sam on April 28, 2019:

I hope people still check this board because I could really use some help. two months ago I started getting small bites on my stomach in the belly button/waistline region and within a few days small dots spread to my back, thighs, and inner arm/elbow areas. the itching was absolute hell, it was all I could think about all the time and id never experienced anything like it so I went to the doctor who said I had scabies. She gave me the standard x2 permethrin treatments with applications one week apart. after the first perm treatment the itching stopped dramatically. I could function again but I was still getting new spots 2 weeks after the second treatment. I went back and she gave me two rounds of Ivermectin to take one week apart. after the first, there was absolutely no difference but after the second Iver dose I was free of spots for about a week. then I started getting 3 or 4 new spots every day again. I went back to my doctor completely devastated and she referred me to a dermatologist who originally treated me for a fungal infection with no improvement. my second visit to them, a little over a week ago, they did a scraping for scabies and didn't find any evidence of mites. She told me I was just stressed and prescribed cream to help with the itching and pills to help me sleep. I felt like they weren't taking me seriously so I went to another dermatologist a few days later when I was still getting spots.

Throughout this whole ordeal every few days I've seen tiny crawling bugs on me. When I notice them on me they just look like a tiny grey/black dot. I managed to trap two in plastic bags a few days ago. They are barely even big enough for me to make out a body shape but if I look very very closely I can see antenna or little legs. I only ever notice them because they tend to crawl rather quickly (in my opinion) around my hands (although I don't have the typical bites between my fingers) or I will happen to see them when I am checking for new spots on my body. Especially on my stomach, I sometimes will feel a sharp pinch or irritation and when I investigate it I will see one of these tiny things is crawling nearby. When this has happened a small red bump has always developed in the same area. Even more rarely I'll see even TINIER ones that are clear. I can only notice them because I just happen to be looking in the right spot and I see them crawl, usually onto something I'm holding or around my fingertips.

At the visit with the newest dermatologist, I took one of these bugs but she wasn't any help in identifying it. she said she had never seen a scabies mite outside of the skin so wouldn't know what it looks like otherwise. I'm waiting on biopsy results for one of the small bumps but the dermatologist proscribed me another dose of Ivermectin and perm (probably because I was near hysterics with frustration). I'll be doing those treatments again but I am 100% sure whatever these bugs are is whats causing my bites. my doctors not believing that scabies can be seen is enough to drive me insane. I've seen mixed information on whether scabies mites are visible or not and I guess the consensus from medical personnel is they don't know?

My question is has anyone else seen the mites? if this is scabies I can't be the only one who's had this experience...I feel like I'm losing my mind. I've spent the night looking for entomologists in my area I can take one of these damned things to for an identification since doctors don't seem to know. I am beyond desperate to get back to my normal life.

Scabies Terminator on January 16, 2019:

I thought I’d share my experience here since so much of the information found online and even among health professionals seems to be so incomplete — especially when it comes to post-treatment. I was treated with benzyl and ivermectin. The very first treatment of benzyl worked wonders to alleviate the itching and subsequent stress. I felt “treated” on that regard on week three, even though I tried to be very careful with clothing, bed clothing, desinfecting sofa, etc. I’m now on week 6/7 and apparently I’m one of those who has post-scabies syndrome or nodular scabies which translates to a few nodules of a few millimeters that persist. The itching is very residual and doesn’t happen everyday and is nothing compared to what scabies was which was almost constant. I’m not sure if these nodules were my fault because of intense scratching. From what I have read they can take up to a few months to heal because the body is getting rid of the debris and maybe some other processes somewhat unknown. I hope they won’t leave a scar. Because of the benzyl (I did like 5 applications of it) my skin was clearly dry and damaged but it’s getting better. My doctor prescribed hydrocortisone and I’m also using aloe Vera gel. I do have lonely red spots that seem like an allergy that can last to a few hours and then disappear. Well, anyway, here’s a shout out to anyone going through these processes. These scabies guys are the worst and even dead just cause enormous trouble and stress. But it gets better, there’s life after scabies. PS: I don’t think I will ever know how I got these.

Had the same experience on October 21, 2018:

It’s now been over a month since the second permethrin treatment. I have the remnants of two nodules going away and the scars are fading. No more itchiness related to scabies. One thing has happened which was a little disconcerting. I decided to go back to my hot yoga class about a week ago. Within 24 hours I broke out in about 40 small bumps on my arms, legs, fingers and hips. Some are itchier than others. I’m almost positive it’s not scabies. The bumps don’t ooze, are much smaller and not as raised, and they don’t itch anywhere near the intensity of the scabies itch. I’m thinking my skin has become hypersensitive from using permethrin and/or my body’s immune response is on high alert. I get a hive if I accidentally scrape my arm on something or if I use any soap with fragrance. I have never been sensitive to anything prior to scabies. I’m hoping this response to stuff will eventually subside. The new bumps are slowly going away and I don’t have any new ones. No more hot yoga for me I guess.

Had the same experience on October 01, 2018:

I'm now a little over two weeks past the 2nd permethrin treatment. It worked! Like I said in a previous post, 24-48 hours after each permethrin treatment I broke out in a rash in different areas which my doctor said was an irritant contact reaction to the permethrin. It really freaked me out as I wondered if the treatment had worked. Everything is now about 90% healed, although I have red spots where the bumps were. Initially, I had scoured the web day after day, looking for information. When different natural treatments I tried didn't help and the itchy rash kept spreading, I made an appointment with a dermatologist. I was diagnosed with scabies about one and a half months after the first bumps appeared. The first dermatologist I went to diagnosed me with eczema. I questioned the diagnosis because it didn't look like eczema to me as I have family members who have it. Thankfully I got a second opinion. Who knows how long I would have walked around with scabies if I hadn't. The biopsy that the first dermatologist did came back saying it was" eczematous dermatitis most consistent with an arthropod bite," although no evidence of the scabies mite was present. I also didn't have burrowing and it started on my right thigh (I guess it tends to start on the hands or feet). I guess maybe that is why the first dermatologist discounted scabies. The second dermatologist took one look at the report and my rash and said that it looked like scabies. I'm taking the time to write here to help others that are suffering with this and because I found this post one of the most helpful I found when I was searching the web. When I didn't know what the rash was at first, I tried apple cider vinegar, tea tree oil, rubbing alcohol, MMS, ozonated olive oil, and ozone therapy. One of these things, I don't know which, might have slowed the spread of the rash, but every day I kept breaking out with new fluid-filled itchy bumps until it covered both my legs and was fast spreading to my arms.

Mark Watts on September 25, 2018:

Permitin NEVER worked for me or my family..we were 100% rigorous with cleaning etc and covered ourselfs in this cream for 5 MONTHS!! It THRIVED on this cream!! All this ads for creams are useless ..you got to go with the ppl that are not with these companies promising cures..

Had the same experience on September 23, 2018:

Thank you for telling your story, as it helped me get through the post scabies experience. I broke out in a seemingly more severe rash within 24-48 hours after each permethrin application (I did two). I'm convinced it was an irritant contact