Healthy Skin Program – Australian Government Scabies Treatment Plan

The Healthy Skin Program is a government initiative in Northern Australia where scabies is endemic in many Aboriginal communities.

This has long been a known problem, and one of the reasons tea tree oil became such a well-known treatment for scabies in Australia (the tea tree plant originates in Australia and New Zealand).

The Healthy Skin Program is a useful tool for us in learning how to treat scabies because with such a large population affected, they can test and refine the treatment protocol to see what works best.

We can then use that information in our own scabies treatments!

Let’s get right to it.

How does the Healthy Skin Program recommend treating scabies?

You are welcome to read the whole document, but I will repost the relevant sections here:

• Treat persons older than 2 months with 5% permethrin cream. Treatment should be applied
late in the afternoon or evening, left on overnight (8–12 hours) and washed off in the morning. It
must be applied from head-to-toe, ensuring the whole body is covered but avoiding the eyes and mouth. Make sure that the cream covers between the fingers and toes, soles of feet, under nails, behind ears, the groin, bottom and genitalia. Wear gloves while applying the cream to others. This treatment should be repeated at 1-2 weeks, and a clinic recall is recommended to ensure that this takes place.

• Treat infants less than 2 months of age with crotamiton 10% cream (Eurax) daily for 3 days. Leave cream on for 24 hours. Permethrin is not recommended for use on children less than 2 months of age

• If there have been 2 or more presentations of scabies where permethrin 5% has not worked
AND reinfection is thought to be unlikely (child treated properly in clinic and all contacts treated),
treat with whole-body application of benzyl benzoate. Leave the lotion on for 24 hours, and
repeat treatment in 1 week. Do not use benzyl benzoate in children under 6 months of age. For
children 6-23 months dilute benzyl benzoate 25% with 3 parts water and for children 2-12 years
of age dilute with equal parts water. In children over 12 years of age and in adults use full
strength benzyl benzoate 25%. Benzyl benzoate occasionally causes severe skin irritation which
usually resolves in 15 minutes. In older children and adults if there is a reaction which settles
quickly, further doses of benzyl benzoate 25% can be diluted with equal parts water and
administered with or without an oral antihistamine.

• Oral ivermectin can also be used for treatment of typical (non-crusted) scabies where topical
treatments have failed or are contraindicated.16,20 Ivermectin should not be used in children
under 5 years of age or less than 15kg in weight. Ivermectin should not be taken during
pregnancy, and unless pregnancy testing is practical, it should not be given to females who could be pregnant. A medical consult is required prior to use of ivermectin, and an infectious
diseases physician can be consulted if the doctor is unfamiliar with this medication.

• All members of the affected household should be treated for scabies, even if they have no
clinical evidence of scabies. This is because scabies has a long incubation period, and other
household members may be infected but asymptomatic.

• Encourage the family to wash clothes and sheets with washing powder and dry in the sun, and
to air mattresses, pillows and blankets in the sun.

How does this compare to the Scabies Home Remedies treatment?

The treatment is more or less the same as what I’ve recommended here on this blog.

They recommend permethrin treatment with 5% permethrin cream. They also recommend it should be repeated after 1-2 weeks.

I would say it’s best to do the second treatment strictly on the 7th day, rather than “after 1-2 weeks”, but the approach should work nonetheless.

They also recommend ivermectin, but only if permethrin hasn’t worked.

I find this is a backwards approach – ivermectin is very safe and it makes more sense to treat with both ivermectin and permethrin at once to give yourself the best chance of really nuking all scabies at once.

However, perhaps it is due to cost or drug availability they recommend treatment this way.

Finally, they recommend all members of the household be treated, and to wash all clothes and sheets and leave in the sun. That’s the same as my recommendation in my guide.

Additionally, I also recommend pairing your treatment with natural treatments that have been proven to work in studies, including tea tree oil, clove oil and neem which they don’t recommend in this guide, but those are supplemental treatments rather than the main course.

Benzyl Benzoate – A New Treatment?

I was surprised to read about this here because I’ve never seen it mentioned anywhere else, and I have spent a lot of hours researching and reading about scabies online.

A quick Google tells us benzyl benzoate is an organic compound which is used as an insect repellent.

It is on the WHO list of essential medicines, and is sold under the brand name Scabanca.

But does it work?

The first study I found compared ivermectin, permethrin and benzyl benzoate.

Here are the results:

Benzyl benzoate had a 92% cure rate after two weeks.

Permerthin had a 96.4% cure rate after two weeks.

Ivermectin had a 100% cure rate after two weeks.

So while it’s slightly inferior to permethrin and ivermectin, it still proves to be very effective.

The next study I found was one done in Nigeria which compared ivermectin and benzyl benzoate.

The results were as follows:

The overall cure rate after 4 weeks was 95% in the ivermectin group and 86% in the topical treatment group (P = 0.04). Compared with topical benzyl benzoate and monosulfiram in the treatment of scabies, ivermectin was at least as effective and led to more rapid improvement.

Again, ivermectin is superior, but benzyl benzoate is still pretty good!

This is very interesting to me.

Permethrin and ivermectin have long been the mainstays of scabies treatment, but benzyl benzoate now offers a good third option (well, it always has apparently, I just never knew about it).

Treating children for scabies

The other interesting thing in the Healthy Skin Program is their guidelines on treating children.

They recommend infants under 2 years old should be treated with crotamiton cream (brand name Eurax).

They don’t recommend permethrin for children of that age.

A Google search on Crotamiton shows it’s a drug used as a scabicide. It is a lotion-based medicine used specifically for scabies.

Again, this is a drug I had never heard of before reading this guidebook.

It is quite fascinating to me we actually have four known clinical scabicides available, when previously I had only known about two.

Of course, since crotamiton, benzyl benzoate and permethrin all pretty much do the same thing (topical scabicide), I don’t think all need to be used in tandem.

Ivermectin is the only internal treatment, so it makes sense it should be the core treatment, and one of the topicals can be selected on top of that.

And of course, the natural treatments recommended in my scabies guide can all continue to be used alongside the clinical treatments.

You can read through the rest of the Healthy Skin Program in your own time, but I’ve broken down the important points for you above.

Personally I think it’s great a guide like this is out there! It gives us some official documentation on best scabies treatment practices from a government dealing with it on an endemic scale.

However, of course I’m biased, but I do think my 30 day treatment plan is slightly more comprehensive and effective.

It contains more treatments, and is more aggressive while still being safe.

Whatever treatment plan you choose, it’s great we have so much info out there to help us, especially when so many doctors are not so knowledgeable on scabies and how to treat it properly.

Wishing you health!

Jon