What is a summary of the latest article on scabies (Sarcoptes scabiei infestation)?

From the Guidelines

Scabies treatment should prioritize a combination of topical and oral therapies, particularly for crusted scabies, with a recommended regimen of 5% topical permethrin cream and oral ivermectin 200 ug/kg on days 1,2,8,9, and 15, as this approach has shown to be effective in reducing morbidity and mortality 1. The treatment of scabies, especially crusted scabies, is crucial in preventing further complications and reducing the risk of transmission. Key considerations in the management of scabies include:

• The use of topical scabicides, such as 5% permethrin cream, which should be applied from neck to toes and left on for 8-14 hours before being washed off 1.
• The administration of oral ivermectin, which is particularly useful in cases of crusted scabies or when topical treatment is not feasible 1.
• The importance of treating all household contacts simultaneously, even if asymptomatic, to prevent reinfestation 1.
• Environmental decontamination, which includes washing bedding and clothing in hot water and isolating non-washable items for at least 72 hours 1. In cases where symptoms persist after treatment, it is essential to consider the possibility of post-scabies dermatitis, which may require symptomatic management with antihistamines and topical steroids 1. Additionally, retreating 2 weeks after the initial treatment regimen can be considered for those persons who are still symptomatic or when live mites are observed, and an alternative regimen may be recommended for those who do not respond initially to the recommended treatment 1.

From the FDA Drug Label

DESCRIPTION Permethrin Cream, 5% is a topical scabicidal agent for the treatment of infestation with Sarcoptes scabiei (scabies). The FDA drug label does not answer the question.

From the Research

Summary of Latest Article on Scabies

• The latest studies on scabies treatment suggest that topical permethrin is the most effective treatment for classic scabies 2.
• A study published in 2018 found that 5% permethrin cream, applied once daily for two consecutive days, is more effective than a single application in adult immunocompetent patients with scabies 3.
• Another study published in 2013 compared the efficacy of topical ivermectin vs. permethrin 2.5% cream for the treatment of scabies, and found that two applications of topical ivermectin provided a cure rate of 63.1% at the 2-week follow-up, which increased to 84.2% at the 4-week follow-up after repeating the treatment 4.
• Oral ivermectin has also been shown to be an effective treatment for scabies, with a study published in 2001 finding that 82.6% of patients in the ivermectin group showed marked improvement after four weeks, compared to 44.44% of patients in the lindane group 5.
• A review of the literature published in 2003 found that among local treatments, permethrin 5% cream seems slightly superior to lindane and less toxic, but its relative efficiency over local treatment has not been established 6.

Treatment Options for Scabies

• Topical permethrin is considered the most effective treatment for classic scabies 2.
• Oral ivermectin is an effective treatment for scabies, particularly in cases where topical treatment is not feasible or effective 5, 6.
• Other treatment options include topical lindane, crotamiton, benzyl benzoate, and sulfur, but their efficacy and safety profiles vary 4, 6.

Efficacy of Treatment Options

• Topical permethrin: 61.8% to 87.2% cure rate after two applications 3.
• Oral ivermectin: 63.1% to 84.2% cure rate after two applications 4.
• Topical lindane: 44.44% cure rate after four weeks 5.
• Crotamiton: inferior to permethrin and lindane 6.
• Benzyl benzoate: efficacy not established compared to permethrin 6.