Scabies Treatment in Bangkok: Permethrin, Ivermectin and Household Care
How Doctor Bangkok diagnoses and treats scabies properly, including the contacts you need to treat too.
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician, Doctor Bangkok
Scabies is an itchy skin infestation caused by the mite Sarcoptes scabiei. It spreads by prolonged skin contact, itches worst at night, and is cured by a two-dose course of topical permethrin 5% or oral ivermectin, combined with simultaneous treatment of household contacts and a specific cleaning routine. At Doctor Bangkok we confirm the diagnosis clinically or by dermoscopy, prescribe the right treatment, and walk you through the household steps that decide whether it actually clears.
From the clinic: Scabies is under-diagnosed because clinicians and patients both assume it has to be filthy or obvious. It does not. Middle-class travellers, hotel guests, yoga retreat attendees and healthcare workers all catch it. The clue is the pattern of itch: worst at night, sparing the face in adults, with burrows in the finger webs and wrists. Once you see it you cannot unsee it, and once treated properly it clears. Most failures I see in clinic are not treatment failures but household failures.
What scabies is and how you catch it
Scabies is caused by a microscopic mite that burrows into the top layer of skin to lay eggs. It transmits through skin-to-skin contact lasting more than 15 to 20 minutes, which is why it spreads in families, sexual partners, shared beds, and care settings rather than brief handshakes. Incubation is 3 to 6 weeks on a first infestation and 1 to 3 days on a re-infestation, because the itch is an allergic reaction to the mite that takes time to develop. Crusted (Norwegian) scabies is a severe form seen in immunosuppressed patients and is much more contagious.
| Scabies | Eczema or heat rash |
|---|---|
| Itch worst at night | Itch throughout the day |
| Finger webs, wrists, waistline, genitals | Flexor creases, face in children |
| Linear burrows on exam | No burrows |
| Household members also itching | Usually single person affected |
| Worsens with steroid cream alone | Improves with steroid cream |
| Needs permethrin or ivermectin | Treated with moisturiser and steroid |
How we recognise it
The classic features are intense itch worst at night, a fine papular rash in the finger webs, wrists, elbows, armpits, waistline, genitals and buttocks, and linear burrows, which look like thin grey wavy lines a few millimetres long. In infants and elderly patients the face and scalp can be involved; in adults they are usually spared. We confirm the diagnosis with a clinical examination, dermoscopy, or, rarely, a skin scraping. Scabies is often mistaken for eczema, and eczema treatments like topical steroids alone make it worse; if steroid cream is not helping an itch after a week, think scabies.
Treatment: permethrin, ivermectin and household care
First-line treatment is permethrin 5% cream applied from the neck down (including head and scalp in infants), left on for 8 to 14 hours, and repeated in 7 days. Oral ivermectin 200 micrograms per kg, two doses a week apart, is used when topical treatment is impractical or in crusted scabies, and is supported by CDC and WHO. All household members and close-contact partners should be treated simultaneously whether or not they itch. On treatment day, wash all bedding, towels and clothing worn in the preceding 3 days in hot water and dry on high heat, or seal in a plastic bag for 72 hours. The itch can continue for 2 to 4 weeks after successful treatment because the allergic reaction outlasts the mite; this does not mean treatment failed. An antihistamine and a topical steroid cover the post-scabies itch.
When to see a doctor
Book an appointment for unexplained itch that is worse at night, any itchy rash that fits the classic distribution, or an itch that is spreading in a household. Seek same-day care if the skin becomes painful, red, hot or weeping, which suggests secondary bacterial infection and may need antibiotics alongside scabicidal treatment. Crusted scabies, extensive thickened scaly plaques in an immunosuppressed patient, also needs urgent treatment because of the transmission risk to others.
Red flag: If red-flag symptoms appear, do not wait. Book same-day or present to the nearest emergency department as described above.
Prevention and what to do at home
Prevention is mostly about stopping re-infection once you have been treated. Treat all household and sexual contacts simultaneously, not in sequence. Wash everything washable on the day of treatment and bag the rest for 72 hours; mites do not survive off the body that long. Do not share towels, bedding or clothing until everyone has completed both doses. Deep cleaning and fumigation are not necessary and waste effort; the mite cannot jump or fly and does not live in carpets. If the itch has not settled 4 weeks after the second dose, come back for review.
Summary
Scabies is one of the few itchy skin conditions that is actually curable in a single visit, provided the treatment is correct and everyone who needs treating gets treated. The mistakes that cause recurrence are predictable: skipping the second dose, missing a household contact, using steroid cream alone, and panicking when the itch continues for a few weeks after the mite is gone. As Dr. Pitsuwan puts it: “Scabies is a household diagnosis, not an individual one. Treat the bedroom, not just the patient.” Doctor Bangkok offers same-day assessment from our Sukhumvit clinic and as part of our wider 24/7 medical services.
Frequently asked questions
How long does scabies itch last after treatment?
The post-scabies itch can last 2 to 4 weeks because it is an allergic reaction, not an active infestation. An antihistamine and topical steroid help. It does not mean treatment failed.
Do I need to treat my family if they do not itch?
Yes. Close household contacts should be treated simultaneously. On a first infestation the itch takes 3 to 6 weeks to develop, so contacts can be infectious before they feel anything.
Is scabies a sexually transmitted infection?
It can be, because prolonged skin contact transmits it. It is not strictly an STI, but sexual partners should always be treated.
Can I get scabies from a hotel bed?
It is possible but uncommon. The mite survives off the body for only 24 to 36 hours. Direct skin contact is the usual route.
Is permethrin or ivermectin better?
Both are effective. Permethrin cream is first line for most people. Ivermectin is used for crusted scabies, institutional outbreaks, or when topical treatment is impractical.
How soon can I return to work or school?
After the first application of permethrin or the first dose of ivermectin, you are no longer considered contagious and can return to work or school the next day.
Sources
- Centers for Disease Control and Prevention (CDC). Scabies: Resources for Health Professionals. cdc.gov.
- World Health Organization (WHO). Scabies fact sheet. who.int.
Scabies, Sarcoptes scabiei, scabies mite, burrows, nocturnal pruritus, crusted scabies, Norwegian scabies, permethrin 5% cream, oral ivermectin, benzyl benzoate, sulfur ointment, post-scabies itch, dermoscopy, skin scraping, household contacts, close contact transmission, secondary bacterial infection, impetigo, CDC scabies guidance, WHO scabies fact sheet, antihistamine, topical corticosteroid, Dr. Ponlawat Pitsuwan, Doctor Bangkok.