OTC medications for scabies or crabs?

Dear Student/Aspiring Troubled Teen Counselor,

Scabies and crabs are actually two different organisms (both can easily spread from person to person) and, thus, are treated in two separate ways. Currently, there are no over-the-counter (OTC) treatments for scabies. However, knowing more about how the little buggers are spread and treated can help you know what to do in the event of an infestation (more on that in a bit). For information on treating crabs (a.k.a., pubic lice), including which OTC products to use, see Pubic lice/crabs...Get them off of me! in the Go Ask Alice! archives. If you suspect that you have scabies or crabs, it is highly recommended to see your health care provider as soon as possible.

Scabies is caused by a microscopic mite called Sarcoptes scabei. These menacing little mites burrow into the upper layer of the skin where it hangs out and lays its eggs. A person may contract scabies through direct, prolonged, skin-to-skin contact with another person who already has scabies (meaning it’ll take more than a quick handshake). While it’s commonly spread among sexual partners, it can also be spread among members of the same household. Transmission is also possible (though less likely) through bedding, clothing, and towels.

The most common symptoms of scabies are intense itching, especially at night, and a pimple-like rash. Little burrows (tiny grayish or skin-colored lines) may also be visible on the skin. The itching and rash can affect large parts of the body or be confined to areas with skin folds such as the wrist, elbow, armpit, fingers (especially between the fingers), nipples, penis, waist, and buttocks. In young children and babies, the head, face, neck, palms, and soles may be involved as well (but not usually adults or older kids). Moreover, constant itching runs the risk of causing infected sores.

Fortunately, scabies is easily treatable with scabicides — medications especially developed to kill scabies mites (and sometimes their eggs as well). These medicines can only be obtained by getting a prescription from your health care provider following a positive diagnosis (typically by visual examination and identification of mites, eggs, or mite fecal matter). They will prescribe the most appropriate scabicide for your needs. Scabicide lotion or cream must be applied all over the body, with the exception of the head and face. The lotion is left on the skin for an extended period of time (as indicated) and then washed off with soap and water. If itching continues or if rashes/burrows reappear after two to four weeks, retreatment may be recommended. Additionally, treatment of any folks in close contact with someone who’s been diagnosed with scabies, including other household members and sexual partners, is also advised. To alleviate some of the itching after the prescription medication is used, cool compresses, soaking in cool water, calamine lotion, or OTC antihistamines may provide some relief (though by themselves will not eliminate the mites).

It’s also good to treat bedding, towels, and clothing that the infected person used prior to treatment. These items need to be either washed in hot water and dried in a hot dryer or dry-cleaned. Mites can live on many surfaces for two to three days, so cleaning furniture and vacuuming carpets well is also recommended. For items that cannot be washed easily, such as stuffed animals, it’s advised that body contact with those items be avoided for at least 72 hours.

If you suspect that you're dealing with these little buggers, consulting your health care provider can help you say hello to happier skin… and bye-bye to those burrowers!