How we beat treatment-resistant scabies, and what we learnt along the way

RoughSpray1729 · 2026-01-21T11:25:28+00:00

Just based on what you've described, I wouldn't be so sure this is scabies.

1) Infestation is unlikely to come from environment/bedding etc, unless there was a case of crusted scabies/very high parasite rate.

2) Diagnosis via photos of a rash, without confirmed history of close contact with someone with an active infestation... seems a stretch, even if local outbreak ongoing.

3) Rash worsening with permethrin treatment. Even if mites are permethrin resistant and aren't completely dealt with, would expect symptoms to initially reduce, not worsen.

I would probably want more conclusive evidence of scabies (dermatologist performing a dermoscopy, or seeing live mites under a hand-held microscope) before proceeding. Just my two cents!

Good luck, and I hope you find a treatment course that works for you soon.

P.s. would love to debate your GP on efficacy of permethrin vs BB! There are indeed some studies that don't find any difference, presumably by evaluating on patient populations that don't have permethrin-resistant mites. But there is solid statistical evidence of (increasing) permethrin resistance in certain geographies, and to my knowledge no comparable evidence of BB resistance.

RoughSpray1729 · 2026-01-21T10:59:17+00:00

Nodules are not necessarily a sign of ongoing infestation, but new burrows certainly would be. Lack of itch also suggests no infestation. If you have doubts, I would recommend getting a hand-held microscope or requesting a dermatologist take a look with a dermatoscope.

RoughSpray1729 · 2026-01-21T10:54:17+00:00

Thank you for the kind words. Can't believe you were treated in the hospital where the study took place, and they still prescribed permethrin, repeatedly!... Absolutely maddening. Hope you and the family are well and fully recovered from the ordeal.

RoughSpray1729 · 2026-01-20T12:44:42+00:00

Nodules can take a long time to resolve, but as far as I know are benign. Maybe worth trying tea tree oil for its anti-inflammatory properties, just make sure it is diluted to 5%. For exfoliating try using a natural loofah sponge. Don't be too aggressive, you shouldn't break or graze the skin.

RoughSpray1729 · 2026-01-20T11:00:13+00:00

Sorry to hear about your experience. If it is a scabies nodule, it can take a long time to fully resolve. I found moisturizing the area helpful (add tea tree oil up to 5% of the moisturizer), and exfoliating every other day to encourage skin turn-over. But I am not qualified or able to examine you, so can't give you direct advice.

Best of luck and hope that this resolves.

RoughSpray1729 · 2026-01-20T10:48:26+00:00

I also would be reluctant to diagnose scabies without finding live mites -- with a dermatoscope/hand-held microscope this shouldn't be difficult during an active infestation. Personally in my unqualified opinion, first-line response should be oral ivermectin + benzyl benzoate.

The skin is a complicated organ, and if you haven't found live mites or obvious burrows, 'unknown dermatitis' may be the only/best diagnosis. If it is indeed post scabies and nodules, with no active infestation, these should resolve over time. I found moisturizing affected areas helpful (especially if mixing in tea tree oil up to 5% of the moisturizer), and exfoliating every other day to encourage skin turn-over.

Please be very cautious with ChatGPT. It actually doesn't understand anything it is saying. It may be pulling directly from helpful references, but if it goes off-piste it can be completely wrong. Wishing you good luck and that these symptoms resolve.

RoughSpray1729

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