What is the Second Line Treatment for Scabies?

What if your scabies treatment fails? Well, a physician can use the backup medications or second line treatment for scabies. Know here the mediations used in this phase.

What is the Second Line Treatment for Scabies?

Scabies is a contagious skin condition caused by the mites and can be determined as blisters, rashes and borrows over the skin. A physician usually recommends Permethrin cream to treat scabies, which is also known as the first line treatment. However, in some cases, Permethrin cream is not as effective on scabies, thereby making the doctor look for further treatments. In this scenario, a physician chooses the second line treatment for the patients to treat scabies which includes the medications given below:


Lindane is the common second line treatment for scabies and is prescribed when the primary treatment doesn’t work for the patient. Lindane belongs to the category of medications, scabicides, and pediculicides. It eradicates the lice and mites, however, it doesn’t stop you from getting lice or scabies. Since it is teratogenic in nature, it is not recommended to the nursing mothers and pregnant women.

Lindane is available as both lotion and shampoo for skin and hair/scalp respectively. It is recommended to use one time only. Follow the guidelines of your doctor or the instructions given on the label.

It must be used on the clean, dry skin below the neck and should not be kept more than 8 hours otherwise it may cause seizures. It is the highly toxic drug and should not be used near eyes and mucous membranes. Discontinue it if you notice any irritation or redness.

Never apply lindane to your mouth and into or near your eyes. Wash your eyes immediately if you get lindane accidently into them or rush to doctor if irritation still persists. Use always vinyl or latex gloves while applying the lotion to yourself or someone else. Wash your hand after an application.


Malathion is high on insecticide to kill parasites like head lice, scabies mite, and crab lice. Two applications of malathion liquid are required, one week apart. Besides prescriptions, malathion liquid is available at most of the drug stores. Malathion is effective if use according to the clinical guidelines, however, you can experience skin irritation during its applications. See your physician immediately if the itching becomes severe or intolerable.

Use it over your whole body parts like face, back, finger webs, genitals, feet soles, neck, scalp, and ears, but keep the application away from eyes. Make sure you skin is cool and dry enough before using it. Therefore, you must apply it after a shower. Leave it for at least 24 hours, afterward; you can remove it by having a bath. The second application must be done after seven days.

Keep it away from the children and store it in a cool and dry place, away from the direct light and heat.

Ivermectin (Stromectol)

Besides being a second line treatment for scabies, Ivermectin is an ideal medication for those who have a weak immune system or have crusted scabies. But it is not safe for nursing mothers, children having weight under 15 kg and a pregnant woman. The oral doses of Ivermectin are useful in outbreaks and in the diagnosis of the mentally disabled patients. Several side effects like vomiting, dizziness, chest discomfort and loss of appetite have been reported while using Ivermectin.

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