Ask A Skin Doctor: Nodular Scabies

nodular scabies

How to treat nodular scabies. Dermatologist tips for skin diseases.

Dear Skin Doctor

Doctors are now guessing too what ive got, been suffering a red angry rash around the anus area inner thighs penis and scrotum.

Started with antifungal creams seemed to calm it down slightly  but would come back and spread other places.

Doctor gave me scabies cream however within day two its made it worse. I feel sick and really not coping well with it.

nodular scabies

Dear Patient

Your symptoms are suggestive of Nodular Scabies.

Symptoms of nodular scabies include red nodules on the genitals, buttocks, groin and armpits.

Nodular scabies is thought to be due to a hypersensitivity reaction and it may persist for months after the mites have been eradicated.

Medications used to treat scabies include:

Permethrin cream

Scabies is treated by applying Permethrin 5% cream from the neck to the toes and washing it off after 24 hours. The application is repeated after 7 days to ensure that any mites that may have hatched from eggs are killed.


Malathion lotion

Malathion 1% lotion is applied from the neck to the toes and washed off after 12 hours in adults and 6 hours in children. The application is repeated after 7 days to ensure that any mites that may have hatched from eggs are killed.



Ivermectin can also be taken by mouth at a dose of 200 micrograms/kg body weight (12 mg for persons over 60 kg and 9 mg for persons under 60 kg) and repeated after 2 weeks. Pregnant and nursing women should not use this medication.


Oral antihistamines

Antihistamines can be taken to control the itch. Examples include the non-sedating fexofenadine (Allegra) and loratadine (Claritin) as well as the less sedating cetirizine (Zyrtec). The sedating diphenhydramine (Benadryl) and hydroxyzine (Atarax, Vistaril) are also used to reduce the itch especially if it disturbs sleep.


Steroid and antibiotic creams

Steroid creams like 1% Hydrocortisone are used for nodular scabies to flatten the bumps. Steroids can also be injected into the nodules to soften and smoothen them.


During the first week of treatment the itch may seem to get worse but after the 1st week it should get less.  It could completely resolve by week 4. This persistent itch is due to the fact that the immune system is still reacting to the presence of dead mites and their droppings.  If the itch lasts for more than one month the person may need retreatment.


To ensure effective treatment for scabies, the following should be done:

All household members and close contacts like sexual partners should be treated at the same time even if they do not have symptoms.

Apply the permethrin cream and malathion lotion to dry, cool skin and not wet, warm skin after a bath.

Leave the cream or lotion on the skin according to the manufacturer’s instructions before washing it off thoroughly since they recommend from 8-24 hours.

Wash the bed linen, clothing, towels and any other garments that come in close contact with the body on the day you apply the medication for the first time at a temperature of 122F or 50C. They can also be machine washed and dried using the hot cycle.

Place the items that cannot be washed in a plastic bag for at least 72 hours to kill the mites.

Clean your house thoroughly by vacuuming the carpets and upholstery if cases of crusted scabies. Use a vacuum with a bag and put it in the trash outside the house immediately after vacuuming. For the best results wear a mask and add borax powder to the steam cleaning mix for cleaning the carpets.

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