These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.


To guide PCH ED staff with the assessment and management of scabies.


Scabies is a skin condition resulting from the infestation of Sarcoptes scabies mites.


  • Sarcoptes scabiei mites are transmitted by prolonged direct human contact, and rarely by fomites
  • Pruritus is cased by hypersensitivity to the eggs, faeces and mites
  • A person may have mites and transmit them without having symptoms or signs.


  • Diagnosis is usually clinical
  • The clinical picture of pruritus and primary lesions (burrows, papules, vesicles and pustules) develops at 4-6 weeks after infestation
  • Burrows (long tracks) are commonly not seen in children
  • Pruritus is worse at night, and may manifest as irritability in infants
  • Distribution:
    • facial involvement is uncommon in children < 5 years
    • infants – usually palms, soles, axillae and scalp
    • children - usually involve web spaces of fingers, flexor surfaces of arms/wrists/axillae and waistline
  • Persistent lesions at 1 month suggest reinfection or persistent infection
  • Secondary excoriation and bacterial infection is frequent
  • Lichenification may occur with chronic infection.


  • Mainstay of treatment is topical antiparasitics
    • Treatment failure is relatively common and is usually due to noncompliance
    • A second treatment with permethrin 5% 1-2 weeks later is reasonable
  • Children under two years old must be treated all over with antiparasitic preparations: include skin folds and face, avoid mouth and eyes
    • Apply over entire body to cool, clean, dry skin
  • Older children should be treated from chin down; this includes ears and nape of neck into hairline for best results
  • Asymptomatic family members and close contacts (babysitters, grandparents) should be treated at the same time

  • Pruritus frequently takes one week or more to resolve after treatment
    • Eurax or Calamine lotion (both available without prescription) may be indicated to control itch until symptoms resolve
  • Consider treatment of secondary infection: Mupirocin (Bactroban), or oral antibiotics if more extensive.

Further management

  • Bed linen and clothing should be washed in hot washed and sun dried
  • For clothes where this is not possible, items should be ironed or stored in a plastic bag for 72 hours.

Permethrin 5% (e.g. Lyclear)

  • Cream disappears when rubbed gently into skin
  • Reapply to hands if washed within 8 hours of application
  • Rinse after 8-14 hours with warm soapy water
  • Repeat after 7 days
  • Most lesions clear after a single application
  • May cause a mild, transient stinging sensation.
  • Children >12 years apply up to one 30g tube
  • 5-12 years up to 1⁄2 tube
  • 1-5 years up to 1⁄4 tube
  • 2-12 months up to 1/8 tube
  • Adults may occasionally require more than a single tube for coverage.
  • Limited data regarding use in pregnancy, but suggests risk of fetal toxicity is minimal. This is the current KEMH recommendation for treatment of pregnant and breast feeding women.
  • Australia product information recommends use in infants 6 months or older, however , the equivalent US information confirms both safety and efficacy in infants 2 months of age and older. Safety and efficacy below this age is not established.

Note that PCH pharmacy will fill scripts for adult contacts of paediatric patients - Scabies Prescription for Patient Contacts


  • Contact Precautions - gloves and long sleeve gowns
  • Place all linen in a plastic bag and then into the usual laundry bag.


  1. WA Health OD 2043/06 - Insecticide Treatments For Scabies, Head Lice, Body Lice, Pubic Lice. Thursday, 30 March 2006
  2. Australian Medication Handbook Children's Dosing Companion, Australian Medicines Handbook Pty Ltd, 2015. Online at: https://children’
  3. WA Health. Child and Adolescent Health Service Infection Control Manual – Lice and Scabies, March 2014

Endorsed by:  Director, Emergency Department  Date:  Jul 2018

 Review date:   Jul 2021

This document can be made available in alternative formats on request for a person with a disability.