Crusted Scabies and Multiple Dosages of Ivermectin

May 2013 | Volume 12 | Issue 5 | Case Reports | 584 | Copyright © May 2013

Alex G. Ortega-Loayza MD, Calvin O. McCall MD, and Julia R. Nunley MD

Department of Dermatology, Virginia Commonwealth University, Richmond, VA
Section of Dermatology, McGuire VA Hospital, Richmond, VA

table 1
a 7-dose regimen (days 1, 2, 8, 9, 15, 22, and 29), depending on the severity of the infestation.5 However, the grade of severity was not specified in these publications.
Although ivermectin is not approved by the US Food and Drug Administration for use in scabies, current literature supports its safety and efficacy. To maximize bioavailability, ivermectin should be administered with food.5 Our patient did not have any liver disease, but it is important to highlight that caution is advised when administering multiple doses of ivermectin in patients with severe liver disease.5
Our case supports the use of a more prolonged course of oral ivermectin for crusted scabies in those who fail the initial 2-dose regimen. It is also an unusual case that demonstrates the effectiveness and safety of ivermectin in an uncomplicated bone marrow transplant recipient. More studies are necessary to provide a grading scale to determine the severity of crusted scabies and to evaluate which dosing regimen would be best, given a specific severity.


The authors have no relevant conflicts of interest to disclose.


  1. Robert LJ, Huffam SE, Walton SF, Currie BJ. Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature. J Infect.  2005;50(5):375-381.
  2. Geary TG. Ivermectin 20 years on: maturation of a wonder drug. Trends Parasitol. 2005;21(11):530-532. 
  3. Guzzo CA, Furteck CI, Porras AG, et al. Safety, tolerability, and pharmacokinetics of escalating high doses of ivermectin healthy adult subjects. J Clin Pharmacol. 2002;42(10):1122-1133. 
  4. Hengge UR, Currie BJ, Jäger G, Lupi O, Schwartz RA. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis. 2006;6(12):769-779. 
  5. Currie BJ, McCarthy JS. Permethrin and ivermectin for scabies. N Engl J Med. 2010;362(8):717-725. 


Alex G. Ortega-Loayza