Rashes that spread · 4 weeks
Family Scabies Treatment
A step-by-step plan to treat scabies in the whole household at once, once a pharmacist or doctor has confirmed it, and stop it coming back.
- Length
- 4 weeks
- For
- Women, Men, Children (with a parent)
- Evidence A
- Strong evidence: guidelines or reviews of trials
- What to expect
- Treatment on day 1, and a repeat when the pharmacist or doctor advises (usually 7 days later, on day 8). Itch can continue for 2–4 weeks after successful treatment.
The goal: Mites gone from everyone at home, laundry handled, itch settling.
Cochrane review of permethrin and ivermectin (A). Treatment is chosen by a pharmacist or doctor; on darker skin the rash shows as dark bumps rather than red.
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The plan
Week 1
Confirm & treat everyone
Pharmacist or doctor confirms; everyone at home treated the same day; laundry washed or bagged.
Treating all contacts together is what stops the cycle (Cochrane).
Morning
Fragrance-free moisturiser
Apply within 3 minutes of patting dry, while skin is slightly damp: a 10-cent-coin amount for face and neck, pressed in, not rubbed hard.
Why: Humectants pull water into the outer layer; occlusives and ceramides seal it in, reducing transepidermal water loss.
Treatment day (once)
Confirm it is scabies (pharmacist or doctor)Doctor or pharmacist
Very itchy rash, worse at night, between fingers, wrists, waist, armpits or genitals, often in several family members: show a pharmacist or doctor before treating. Your doctor or pharmacist will advise the dose and how long.
Why: Other itchy rashes look similar; a confirmed diagnosis avoids unnecessary chemicals.
Rosumeck et al. Ivermectin and permethrin for treating scabies (Cochrane, 2018) (verify)
Scabies cream for everyone at home, on the same dayDoctor or pharmacist
The pharmacist or doctor will choose the treatment (often permethrin cream) for each person, including babies, pregnant or breastfeeding women and older people, who may need a different medicine or extra areas covered. Apply it to cool, dry skin from the neck down, including between fingers and toes, under nails and the genitals, and wash it off when they say. They will tell you when to repeat it. Benzyl benzoate is common in Nigerian markets but stings and is not suitable for young children; let the pharmacist choose. Your doctor or pharmacist will advise the dose and how long.
Why: Cochrane: permethrin and ivermectin both work well. Treating everyone together stops the mites passing back and forth.
Rosumeck et al. Ivermectin and permethrin for treating scabies (Cochrane, 2018) (verify)
Wash or bag bedding and clothes
On treatment day, wash bedding, towels and recently worn clothes in hot water and dry in the sun, or seal them in a plastic bag for 72 hours.
Why: Mites cannot survive long away from skin; this prevents re-infestation.
Rosumeck et al. Ivermectin and permethrin for treating scabies (Cochrane, 2018) (verify)
Habits
Tell school, boarding house or close contacts
Let the school or hostel know so close contacts can be checked and treated at the same time.
Why: Scabies spreads quickly in boarding schools and crowded homes.
Rosumeck et al. Ivermectin and permethrin for treating scabies (Cochrane, 2018) (verify)
Itch can last after treatment
Itch often continues for 2–4 weeks after successful treatment. Use plain emollient, keep nails short; ask the pharmacist about soothing creams. New burrows or new spots are a reason to go back.
Why: Itch is an allergic reaction to dead mites and their debris, which the skin clears slowly.
Check every pack for a NAFDAC number
Before buying, look for the NAFDAC registration number and an intact seal. Buy from a registered pharmacy, not a market table or social-media seller.
Why: Counterfeit and mislabelled creams are common; some "plain" creams secretly contain steroids, mercury or strong bleaching agents.
Voice of Nigeria: NAFDAC warns against high-hydroquinone skin creams (2025)
Food
Hydration
Water with each meal and whenever thirsty; more in heat and harmattan.
Why: Supports overall health; skin hydration is mostly about the barrier, so pair water with moisturiser.
Week 2
Repeat as advised
Second treatment when the pharmacist says (usually 7 days after the first); wash or bag laundry again.
A repeat treatment catches mites that hatch after the first.
Morning
Fragrance-free moisturiser
Apply within 3 minutes of patting dry, while skin is slightly damp: a 10-cent-coin amount for face and neck, pressed in, not rubbed hard.
Why: Humectants pull water into the outer layer; occlusives and ceramides seal it in, reducing transepidermal water loss.
Repeat treatment day (only if advised)
Scabies cream for everyone at home, on the same dayDoctor or pharmacist
The pharmacist or doctor will choose the treatment (often permethrin cream) for each person, including babies, pregnant or breastfeeding women and older people, who may need a different medicine or extra areas covered. Apply it to cool, dry skin from the neck down, including between fingers and toes, under nails and the genitals, and wash it off when they say. They will tell you when to repeat it. Benzyl benzoate is common in Nigerian markets but stings and is not suitable for young children; let the pharmacist choose. Your doctor or pharmacist will advise the dose and how long.
Why: Cochrane: permethrin and ivermectin both work well. Treating everyone together stops the mites passing back and forth.
Rosumeck et al. Ivermectin and permethrin for treating scabies (Cochrane, 2018) (verify)
Wash or bag bedding and clothes
On treatment day, wash bedding, towels and recently worn clothes in hot water and dry in the sun, or seal them in a plastic bag for 72 hours.
Why: Mites cannot survive long away from skin; this prevents re-infestation.
Rosumeck et al. Ivermectin and permethrin for treating scabies (Cochrane, 2018) (verify)
Habits
Itch can last after treatment
Itch often continues for 2–4 weeks after successful treatment. Use plain emollient, keep nails short; ask the pharmacist about soothing creams. New burrows or new spots are a reason to go back.
Why: Itch is an allergic reaction to dead mites and their debris, which the skin clears slowly.
Food
Hydration
Water with each meal and whenever thirsty; more in heat and harmattan.
Why: Supports overall health; skin hydration is mostly about the barrier, so pair water with moisturiser.
Weeks 3–4
Itch settling
Emollient for itch; watch for new burrows.
Itch fades slowly; new burrows mean the treatment needs reviewing.
Morning
Fragrance-free moisturiser
Apply within 3 minutes of patting dry, while skin is slightly damp: a 10-cent-coin amount for face and neck, pressed in, not rubbed hard.
Why: Humectants pull water into the outer layer; occlusives and ceramides seal it in, reducing transepidermal water loss.
Evening
Fragrance-free moisturiser
Apply within 3 minutes of patting dry, while skin is slightly damp: a 10-cent-coin amount for face and neck, pressed in, not rubbed hard.
Why: Humectants pull water into the outer layer; occlusives and ceramides seal it in, reducing transepidermal water loss.
Habits
Itch can last after treatment
Itch often continues for 2–4 weeks after successful treatment. Use plain emollient, keep nails short; ask the pharmacist about soothing creams. New burrows or new spots are a reason to go back.
Why: Itch is an allergic reaction to dead mites and their debris, which the skin clears slowly.
Short nails, no scratching
Cut nails short for everyone; press or cool the itch instead of scratching.
Why: Scratched skin can become infected and leave dark marks.
Food
Hydration
Water with each meal and whenever thirsty; more in heat and harmattan.
Why: Supports overall health; skin hydration is mostly about the barrier, so pair water with moisturiser.
Milestones
Your weekly check-in
Ask yourself these once a week. If an answer worries you, stop and see a doctor or pharmacist.
Stop and see a doctor if
- Pus, crusts, painful swelling or fever (infected scabies): see a doctor; untreated skin infection can affect the kidneys
- Thick, crusted scaly skin, especially in an older or unwell person (crusted scabies): see a doctor
- Baby under 2 months, or pregnant or breastfeeding: a doctor must choose the treatment
- New burrows or spots after the second treatment
In an emergency, call 112112999911911.
Sources
- Rosumeck et al. Ivermectin and permethrin for treating scabies (Cochrane, 2018) (verify)
- Cochrane: Emollients for eczema
Education, not diagnosis. This plan cannot examine you; pending physician review where marked.
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