Dawaa Reference

infectious

Scabies infestation

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations, with the dose from MSF Essential Drugs 2024, IVERMECTIN oral: ordinary scabies row: "Child over 15 kg and adult: 200 micrograms/kg single dose. A single dose may be sufficient", with a second dose one week later to reduce the risk of treatment failure. MSF puts that second dose at one week against the 14 days given here, which follows the CDC guideline, and MSF states the same 15 kg floor. · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations · Permethrin 5% w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 15508) · Egyptian National Drug Formulary - Antimicrobial 2023 (ivermectin monograph), Pregnancy and Lactation section · Egyptian National Drug Formulary - Antimicrobial 2023 (benzyl benzoate monograph)

Verified against4 documents
  • CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations, with the dose from MSF Essential Drugs 2024, IVERMECTIN oral: ordinary scabies row: "Child over 15 kg and adult: 200 micrograms/kg single dose. A single dose may be sufficient", with a second dose one week later to reduce the risk of treatment failure. MSF puts that second dose at one week against the 14 days given here, which follows the CDC guideline, and MSF states the same 15 kg floor.
  • CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations
  • Permethrin 5% w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 15508)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (ivermectin monograph), Pregnancy and Lactation section

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • Itching affecting several household members or close contacts should raise suspicion for scabies [itching]
  • Some patients have only subtle findings, no known exposure, and lack the classic nighttime itch
  • Severe itching can disrupt sleep and hurt school or work performance [itching]

Signs — what you find (7)

  • A mixed rash of scratched papules, eczema-like or thickened plaques, and nodules is typical [papules · plaques · rash]
  • Burrows are short wavy white lines ending in a small vesicle or erosion, though often hard to spot [blisters · vesicles]
  • In children under 2, lesions often involve finger web spaces, wrists, and trunk, and can also affect the scalp, face, palms, and soles
  • In adults, mites favour skin folds, wrist creases, finger webs, the navel, beltline, nipples, buttocks, and genitals
  • Weeks of scratching can leave excoriation, crusting, thickened skin, prurigo nodules, and secondary bacterial infection [crusting · itching]
  • Honey-coloured crusts point to impetigo, while painful red skin suggests cellulitis as a superinfection [cellulitis · redness]
  • Crusted scabies can cover the hands, feet, palms, soles, scalp, earlobes, and toenails with thick crust [crusting]

Tests (7)

  • Suspected scabies needs a typical rash pattern plus one supporting history feature
  • Calling it clinical scabies additionally requires visible burrows
  • Confirmed scabies needs mites, eggs, or faeces seen on top of the clinical picture
  • Microscopy of skin scrapings can show mites but is slow and prone to sampling error
  • Dermoscopy at up to 10x magnification can show burrows resembling a jet-plane contrail
  • Dermoscopy is limited on dark skin, hairy areas, and the genital region
  • A skin biopsy can confirm scabies but is not advised as routine practice

If not this — what else fits (4)

  • Irritant or contact dermatitis and atopic eczema can coexist with or be mistaken for scabies
  • Flea, bedbug, or chigger bites should also be considered
  • Crusted scabies can resemble hyperkeratotic or dyshidrotic eczema, psoriasis, or Darier disease
  • Bullous scabies must be told apart from lupus erythematosus, bullous impetigo, and pemphigus vulgaris

SourceStatPearls "Scabies" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Topical scabicide when permethrin is unaffordable or unavailable - usable in pregnancy

MAIN TREATMENT - choose one

1

PERMETHRIN

1st line

Formtopical

Adult dose and duration

Apply 5% cream over the whole body from the neck down, including neck, palms and soles, and wash off after 8-14 hours; repeat 7-14 days after the first treatment. Up to 30 g (one 30 g tube) per application x 2 applications separated by 7-14 days

Paediatric dose

(Where to apply splits at 2 YEARS, not at the minimum age of use. Under 2 years: whole body including face, ears and scalp, sparing the skin around the mouth and the eyes. Over 2 years: whole body including neck, palms and soles - the head and face can be spared unless there are lesions there. Amount: 2 months-5 years up to 7.5 g, 6-12 years up to 15 g. Repeat 7-14 days at every age. Licensed from 2 months, but 2-23 months only under close medical supervision. Patients over 65 should have the face, ears and scalp treated as well.)

Dose by age
2 to 23 months:Whole body including face, ears and scalp, sparing the skin around the mouth and the eyes. Up to 7.5 g. Only under close medical supervision at this age. Repeat in 7 to 14 days.
2 to 5 years:Whole body including neck, palms and soles; the head and face can be spared unless there are lesions there. Up to 7.5 g. Repeat in 7 to 14 days.
6 to 12 years:Whole body including neck, palms and soles; the head and face can be spared unless there are lesions there. Up to 15 g. Repeat in 7 to 14 days.
Dose source

Permethrin 5% w/w Cream SmPC section 4.2 Posology and method of administration (eMC product 15508)

Why

Gold standard topical scabicide with high cure rate

Cautions
  • Treat all household and close contacts simultaneously.
  • Wash bed linen and clothing in hot water (>50C).
  • Pruritus may persist for 2-4 weeks post-treatment (does not mean failure).
Egyptian brands
Egyptian brandManufacturerIndicative price
ECTOMETHRIN 2.5 % CREAM 20 GMMISR > APC (ARAB PERFUMES CHEMICALS AND PHARMACEUTICAL CO.)12.00 EGP
ECTOMETHRIN 5 % CREAM. 20 GMMISR > APC (ARAB PERFUMES CHEMICALS AND PHARMACEUTICAL CO.)21.00 EGP
ECTOMETHRIN 5% OINT. 20 GMMISR > APC (ARAB PERFUMES CHEMICALS AND PHARMACEUTICAL CO.)21.00 EGP
NEWCID 1% 60ML SHAMPOOCID9.00 EGP
NEWCID 1% 80ML SHAMPOOCID11.00 EGP
2

IVERMECTIN

2nd line

Strength6 mg

Formoral.solid

Adult dose and duration

200 mcg/kg as a single oral dose taken with water; repeat in 14 days x 2 doses separated by 14 days

Paediatric dose

0.2 mg/kg/dose [child max 15 mg]

(200 mcg/kg (=0.2 mg/kg) single dose; safety not established in children < 15 kg)

Not for children under 15 kg

Dose by weight
15kg3 mg/dose
16kg3.2 mg/dose
17kg3.4 mg/dose
18kg3.6 mg/dose
19kg3.8 mg/dose
20kg4 mg/dose
21kg4.2 mg/dose
22kg4.4 mg/dose
23kg4.6 mg/dose
24kg4.8 mg/dose
25kg5 mg/dose
26kg5.2 mg/dose
27kg5.4 mg/dose
28kg5.6 mg/dose
29kg5.8 mg/dose
30kg6 mg/dose
31kg6.2 mg/dose
32kg6.4 mg/dose
33kg6.6 mg/dose
34kg6.8 mg/dose
35kg7 mg/dose
36kg7.2 mg/dose
37kg7.4 mg/dose
38kg7.6 mg/dose
39kg7.8 mg/dose
40kg8 mg/dose
41kg8.2 mg/dose
42kg8.4 mg/dose
43kg8.6 mg/dose
44kg8.8 mg/dose
45kg9 mg/dose
46kg9.2 mg/dose
47kg9.4 mg/dose
48kg9.6 mg/dose
49kg9.8 mg/dose
50kg10 mg/dose
Dose source

CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Scabies - Recommended Regimens and Special Considerations, with the dose from MSF Essential Drugs 2024, IVERMECTIN oral: ordinary scabies row: "Child over 15 kg and adult: 200 micrograms/kg single dose. A single dose may be sufficient", with a second dose one week later to reduce the risk of treatment failure. MSF puts that second dose at one week against the 14 days given here, which follows the CDC guideline, and MSF states the same 15 kg floor.

Why

Oral scabicide for crusted scabies, outbreaks, or topical treatment failure

Cautions
  • Pregnancy and breastfeeding: not a contraindication. CDC 2021 states ivermectin "likely poses a low risk to pregnant women and is likely compatible with breastfeeding; however, because of limited data ... permethrin is the preferred treatment"; the Egyptian formulary agrees that "use in pregnancy is likely low risk" while other agents are recommended first.
  • Children under 15 kg: CDC 2021 states the safety of ivermectin "for children weighing <15 kg has not been determined" and that infants and young children should be treated with permethrin.
  • Take on an empty stomach with water.
  • Repeat dose in 7-14 days is essential for complete eradication.
Egyptian brands
Egyptian brandManufacturerIndicative price
IVACTIN 6MG 6 F.C.TABS.DELTA PHARMA13.50 EGP (2.25/unit)
IVERZINE 6MG 24 TABS.UNIPHARMA CO. > UNIPHARMA84.00 EGP (3.50/unit)

TOPICAL SCABICIDE WHEN PERMETHRIN IS UNAFFORDABLE OR UNAVAILABLE - USABLE IN PREGNANCY

3

BENZYL BENZOATE

Topical scabicide when permethrin is unaffordable or unavailable - usable in pregnancy

2nd line

Formtopical

Adult dose and duration

Apply the 25% lotion at night after bathing, over the whole body from the neck down; let it dry, apply a second coat, and wash it off the next morning. It may be repeated after 24 hours.

Paediatric dose

Same application as adults, but the formulary says to dilute the lotion first: infants, 1 part lotion with 3 parts water; children, 1 part with 1 to 3 parts water.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (benzyl benzoate monograph) - verbatim: "Scabies: Topical: After bathing, apply to moist skin and allow to dry, then reapply. Apply at night; bathe and remove the drug the next morning. May repeat application in 24 hours if necessary."

Why

The card offers permethrin or oral ivermectin only. Benzyl benzoate is the cheap, everywhere-stocked Egyptian scabicide and the article calls it acceptable in pregnancy and in children, which is where permethrin cost or supply most often bites.

Cautions
  • Do not put it on wounds, burns, broken skin, the face, the eyes or mucous membranes.
  • It stings and burns on application and can cause a contact dermatitis that patients mistake for treatment failure.
  • Dilute it for infants and children, and for elderly patients (1 part lotion with 3 parts water).
  • Wash all bedding and clothing between and after applications, and treat the whole household at the same time.
Egyptian brands
Egyptian brandManufacturerIndicative price
BENZYL BENZOATE 20% CREAM 40 GMPHAROPHARMA3.90 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.