It is pertinent to isolate those infected with crusted scabies, as these patients may easily trigger an epidemic or outbreak of scabies. Fellow household members or hospital staff must take extra precautions in order to avoid being infected as well. The infected individual's nails should be clipped and scabacidals applied, as the nails are a frequent source of relapse. Patients who are paralyzed or moribund require extra care to prevent relapse. Their clothes and bed linens should be washed in hot water during the treatment process.
Treating crusted scabies, in particular, proves to be extremely challenging due to the widespread nature of the infection, as well as compromising the host's immunity system. Treatment of crusted scabies not only includes scabicidal creams, but also keratolytic agents that will remove the thick crusts of skin covering the infected area. Unfortunately, the hyperkeratotic crusts on the skin make it difficult for the topical scabicidals to penetrate and treat the skin alone effectively. It's recommended to find a cream that contains around 5 to 10% of salicylic acid or 40% urea to treat the infection. Hot baths may also be taken to reduce the number mites present as well as aid in the effectiveness of the creams. Patients may inherit a secondary bacterial infection known as septicemia, which should be treated immediately and aggressively with broad-spectrum antibiotics.
The oral drugs and topical agents used to treat the classical form of scabies are also used to treat crusted scabies. However, repeated applications are usually needed, as treating crusted scabies takes much longer than the average scabies infection. Treatments include topical sulfur compounds, malathion, benzyl benzoate, crotamiton, ivermectin, and permethrin. Lindane is typically not the doctor's first choice of medicine, as it is contraindicated, causing an increased percutaneous absorption and potentially risking neurotoxicity of the skin after repeated use.
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