What is the recommended first-line treatment for scabies?

Permethrin cream is recognized as the first-line treatment for scabies due to its effectiveness and safety profile. This topical insecticide works by disrupting the nervous system of the mites causing the infestation, leading to their death. The cream is typically applied to the entire body from the neck down and left on for a specified duration before washing it off, ensuring that it covers all the areas where mites may reside, including skin folds and between fingers.

While other treatments exist, they are generally considered second-line options or used in specific cases. Benzyl benzoate lotion can also treat scabies but may be more irritating to the skin compared to permethrin. Lindane lotion has fallen out of favor due to concerns over toxicity and potential for neurotoxicity, especially in young children and during pregnancy. Oral ivermectin, while effective for scabies, is typically reserved for cases of crusted scabies or in populations where topical treatments may be impractical, such as in certain institutional settings. Therefore, permethrin cream remains the most recommended first-line treatment for scabies.