Scabies in special cases (pregnancy, children, elderly)

Scabies behaves a little differently in pregnancy, in babies and children, and in older adults. The main difference is which medicine is safe and how the rash looks. In all groups, scabies is curable, and treatment should not be delayed.

Pregnancy and breastfeeding

• Permethrin 5% cream is generally regarded as the first-choice treatment in pregnancy and while breastfeeding, and is used under a doctor's advice.
• Oral ivermectin is usually avoided in pregnancy and, without advice, during breastfeeding.
• Sulphur ointment is sometimes used as an alternative under medical guidance.
• Do not use lindane, and do not try strong chemicals, kerosene or unproven oils on the skin.
• Itching is intense, so tell your doctor early. Treat all household members at the same time.

Babies and young children

• The rash often involves the face, scalp, palms and soles, and may include blisters, so it can look different from adults.
• Babies may be irritable, sleep poorly and feed badly.
• Permethrin is usually used, with application to the whole body including the scalp and face (avoiding eyes and mouth). Dosing and the product used must be set by a paediatrician, especially under two months of age.
• Cover hands with cotton mittens if needed, so the baby does not lick the cream off. Keep fingernails short.
• Do not use herbal oils, steam or home mixtures on infants.

Older adults

• Itching may be mild or absent, and the rash may be mistaken for eczema or an allergy, so the diagnosis is often delayed.
• Care-home residents and people with weak immunity are at risk of crusted scabies and outbreaks.
• Skin is dry and fragile, so use moisturiser and watch for infection.
• Kidney, liver and other medicines need review before oral treatment.

Ayurvedic view (interpretive) Traditional care is gentle and cleansing in nature, but evidence is limited. Avoid herbal products in pregnancy and in babies unless a doctor agrees.

When to see a doctor See a doctor promptly for any suspected scabies in a pregnant woman, a baby, an older adult or a person with weak immunity. Seek urgent care for fever, pus, spreading redness or poor feeding in a baby.

Remember Treat the whole household together, and choose medicine with a doctor who knows the age and pregnancy status.