Understanding the First Line and Second Line Treatment for Scabies


Scabies medications are categorized into basic and advance treatment according to the severity of the disease.)

Scabies is a contagious disease caused by the mites. It is a global health problem affecting nearly 400 million people. The symptoms of scabies include blisters, rashes, and burrows with intense itching.

You get scabies mites from the infected person from direct skin contact. Sometimes people get mites from infected items like clothes, bedding and furniture.

Luckily, scabies is curable with a range of medications. The treatment of scabies is based on the severity of the conditions. For example, scabies is likely to be cured with basic medications like topical cream. It is known as the first line of treatment for scabies. Sometimes, it requires more drugs or advanced treatment to treat scabies which is known as a second line of treatment. It is prescribed when first line of treatment fails to work.

Here we have explained both first line treatment and second line treatment for scabies.

First Line of Treatment for Scabies

  • Permethrin Cream (5%):

Permethrin cream is a common scabies medication. In fact, it is considered as the first line of treatment for scabies, meaning that it is the most basic treatment for scabies. The cream belongs to the category of scabicides and pediculicides. The cream eliminates the scabies mites and lice. The cream generally contains 5% permethrin. Permethrin cream is an effective treatment for scabies. It eliminates the scabies mites and their eggs as well. The cream works as it alters the nervous system of the mites due to its toxic effect. The affected nervous system causes muscle spasms, death and paralysis among the mites.

  • Benzyl Benzoate

Benzyl Benzoate kills mites and lice by acting on their nervous system. It is also available without a prescription at most of the drug stores.

Second Line Treatment for Scabies

The first line treatment medications like permethrin cream or benzyl benzoate sometimes don’t work. This is why a physician may prescribe you second line of treatment that includes the medications like lindane, Ivermectin, and Malathion.


Lindane is a common medication for scabies. It works by killing the mites. Apart from scabies, it is used to treat head and crab lice. Lindane belongs to the category of medications called scabicides and pediculicides. However, it doesn’t stop the infestation as it only kills the scabies mites. It is prescribed for those patients who are allergic to other treatment, or for whom the other treatments are failed. It is not recommended for the children under 2 years, pregnant women, elders and nursing mothers.


Oral Ivermectin is used for complicated scabies cases, including crusted scabies or when patients have altered immune system. It is also prescribed when lotions and cream fail to treat. It is not suitable to pregnant/nursing women and kids weighing less than 33 pounds.


Malathion is an insecticide to kill parasites like head lice, scabies mite, and crab lice. It is also available as an OTC drug. Malathion is effective if use according to the clinical guidelines, however, you can experience skin irritation during its applications. Make sure to visit your physician if you experience severe or intolerable itch.

So these are medications for scabies according to the symptoms and improvement of your condition. Make sure to follow your physician’s instructions while using any of these medications for scabies.

It is also important to practice the precautions to aid your healing.

What do you think? Do you have other suggestions to share with us? Do it right now by commenting below!

Leave a Reply

Your email address will not be published. Required fields are marked *