Household Scabies: Ivermectin Versus Permethrin

US CDC¹ guidance lists both 5% permethrin and oral ivermectin for classic scabies. That page, dated December 2023, predates the 2026 SCRATCH comparison. Discuss the newer result alongside each person’s suitability and ability to complete treatment.¹

Design

SCRATCH compared oral ivermectin 200 µg/kg with 5% permethrin cream on days 0 and 10. Children under 15 kg received cream, including in the ivermectin arm. Widespread eczema-like inflammation or impetigo excluded entry.²

Analyses excluded five households for invalid consent: 142 versus 147 households remained (507 versus 568 people, including index cases).²³

Day-28 cure

Cure required every household member to be free of clinical scabies; residual post-scabies itching alone could count as cured. Estimated household cure was 71.8% versus 88.5%, ivermectin versus permethrin: −16.7 percentage points (95% CI −26.3 to −7.1).²

Ivermectin failed the noninferiority rule allowing at most a 10-percentage-point loss of cure. Results favored permethrin.²

Thirty household outcomes were missing and imputed. Assessors were blinded; some household outcomes were self-reported. Funders: French health ministry and dermatology society; companies supplied medicines.²³

US prescribing

The CDC¹ identifies oral ivermectin as off-label for scabies.¹

The US Stromectol label covers particular worm infections. It advises against use during pregnancy and warns about neurotoxicity, including confusion and altered consciousness, and rare increased anticoagulation measurements with warfarin. Mention breastfeeding and exposure to Loa loa-endemic areas of West or Central Africa before prescribing.⁴

The US permethrin 5% cream label covers scabies from two months of age. Allergy to its components, synthetic pyrethroids or pyrethrins is a contraindication. Burning, stinging and temporary worsening of irritation can occur; avoid eye contact. Pregnancy and breastfeeding require individual advice.⁵

Ask the prescriber to write down the exact product, application areas, repeat-treatment dates and what should trigger review. The trial schedule is not a household prescription. Crusted scabies needs a separate plan; CDC¹ guidance describes combined oral and topical treatment.¹

“Describe It Before You Sort It” in Skin, Head to Toe organizes location, appearance and sensation, timing and other symptoms. Keep those details with treatment dates for your follow-up appointment.