Norwegian (crusted) scabies carries an extraordinarily high mite burden (millions of mites) and is a significant nosocomial infection risk. The first-line treatment for Norwegian scabies is:
- A 5% permethrin cream topically — single application
- B Oral ivermectin 200µg/kg on days 1, 2, 8, 9, 15 combined with topical 5% permethrin ✓
- C Oral doxycycline for 6 weeks
- D Topical benzyl benzoate 25% for 1 week
Correct answer: B. Oral ivermectin 200µg/kg on days 1, 2, 8, 9, 15 combined with topical 5% permethrin
Explanation
Norwegian/crusted scabies requires aggressive treatment due to the massive mite burden. The current standard is combination therapy: oral ivermectin on multiple days (days 1, 2, 8, 9, 15 — or at minimum days 1, 8, 15) combined with topical permethrin 5% applied daily or every other day. Keratolytic agents (salicylic acid/urea) are added to remove hyperkeratotic crusts that protect mites from topical agents. Isolation and contact tracing are mandatory. Single-application permethrin is insufficient for Norwegian scabies.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.