If 5% permethrin cream has not worked 4x/6 wks, what is the next step to get rid of possible scabies. Env & fam treated. Treatment was done correctly.

See your doctor . Or health dept. A prescription medicine (lindane)may help if not resolved, but must be used correctly bc of risk of seizures.
Scabies. Permethrin treatment needs to be repeated one week after the initial treatment. There are oral treatments for scabies, like ivermectin. However, the itch of scabies can last up to 6 weeks after proper treatment. As long as you are not seeing new lesions, the scabies is treated and the itch will eventually resolve. A cortisone cream can help with itching but not on days using permethrin.