Guideline for the Diagnosis and Treatment of Scabies―Third Edition―

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  • 疥癬診療ガイドライン(第3版)
  • 日本皮膚科学会ガイドライン 疥癬診療ガイドライン(第3版)
  • ニホン ヒフ カガクカイ ガイドライン カイセンシンリョウ ガイドライン(ダイ3ハン)

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Here, we present our new guideline for the diagnosis and treatment of scabies which we, the executive committee convened by the Japanese Dermatological Association, developed to ensure proper diagnosis and treatment of scabies in Japan. Approval of phenothrin topical use under the National Health Insurance in August 2014 has contributed to this action. Permethrin, a topical anti-scabietic medication belonging to the same pyrethroid group as phenothrin, is already in use worldwide. For making proper diagnosis of scabies, following three points should be taken into consideration: clinical findings, detection of the mite(s) (Sarcoptes scabiei var. hominis), and epidemiological findings. The diagnosis is confirmed when the mites or their eggs are identified by microscopy or by dermoscopy. As we now have a choice of phenothrin, the first line therapy for classical scabies is either topical phenothrin lotion or oral ivermectin. Second line for topical treatment is sulfur-containing ointments, crotamiton cream, or benzyl benzoate lotion. Gamma-BHC ointment is no more provided for clinical use. If the patient is immunosuppressed, the treatment option is still the same, but he or she should be followed up closely. If the symptoms persist, diagnosis and treatment must be reassessed. For hyperkeratotic (crusted) scabies and nail scabies, removal of thick scabs, cutting of nails, and occlusive dressing are required along with topical and/or oral treatments. It is important to apply topical anti-scabietic lotion/cream/ointment below the neck for classical scabies or to the whole body for hyperkeratotic scabies, including the hands, fingers and genitals. For children and elderlies, it is recommended to apply treatment to the whole body even in classical scabies. The dosage for ivermectin is a single oral administration of approximately 200 μg/kg body weight. It should be taken on an empty stomach with water. Administration of a second dose should be considered at one-week with new lesions and/or with detection of mites. Safety and effectiveness of combined treatment with topical and oral medications are not yet confirmed. Further assessment is needed. Taking preventative measures is as important as treating those infected. It is essential to educate patients and healthcare workers and conduct epidemiological studies to prevent further spread of the disease through effectively utilizing available resources including manpower, finance, logistics, and time. (Jpn J Dermatol 125: 2023-, 2015)


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