Comparison of topical permethrin 5% vs. benzyl benzoate 25% treatment in scabies: a double-blinded randomized controlled trial.

BACKGROUND: Scabies is a pruritic parasitic infestation of the skin. High-income countries have reported an increasing incidence over the last few years. Studies have indicated a reduction in the sensitivity of scabies mites to the standard treatment of choice, topical permethrin 5%. OBJECTIVES: To evaluate in a head-to-head manner the efficacy of two topical scabicides [permethrin 5% and benzyl benzoate 25% (BB)] in the treatment of scabies using the same administration modality; and to address potential confounding factors such as incorrectly performed treatment and hygiene measures. METHODS: In total, 110 patients with dermoscopy-verified scabies infestation were enrolled and randomized into two equally sized groups in a double-blinded manner. Fifty-five received topical permethrin 5% and 55 received topical BB 25%, both for daily use over a period of three consecutive days. Treatment outcome was evaluated by dermoscopy at a 3-week follow-up visit. RESULTS: Treatment resulted in a dermoscopy-verified cure rate of 27% in the permethrin group and 87% in the BB group. The tolerability and safety profile of permethrin 5% cream was excellent, while the BB emulsion produced a burning sensation in 43% of patients. CONCLUSIONS: Topical permethrin demonstrated a lack of efficacy in the majority of scabies cases, whereas BB demonstrated an excellent cure rate and reasonable tolerability. Considering the reduced sensitivity of scabies mites to permethrin 5%, our results suggest that BB is an appropriate first-line therapy in the treatment of scabies.

The effect of educational intervention on efficacy of 1% permethrin shampoo and 4% dimeticone lotion to treat head lice infestation using propensity score matching (PSM).

BACKGROUND: Head lice are a main public health problem and the most important human ectoparasites and the use of pediculicides is the most common way to control it. One of the possible causes of treatment failure is the lack of improper application of pediculicide. The aim of this study was to assess the effect of education on efficacy of 1% permethrin or 4% dimeticone lotion to treat head lice infestation. METHODS: This quasi-experimental study included 100 individuals with head lice infestation from comprehensive urban health centers in Ardabil as the intervention group, and 400 individuals from East Azerbaijan and West Azerbaijan provinces as the control group, from April to March 2019. The data collection tools included a demographic questionnaire and an examination recording sheet, which documented the presence of adult lice or nits. Due to the inability to perform random assignment and control for numerous observed covariates, propensity score matching (PSM) was used. RESULTS: The outcome of treatment included elimination of head lice infestation on is 7, and in the case of recurrence, it was considered on days 14 and 30 after treatment. The results showed that the educational intervention program had a significant positive effect on the efficacy of both treatments. The likelihood of improvement was approximately three times greater in the intervention group compared to the control group. CONCLUSION: Participants who received the training intervention (OR = 3.29; CI 95%: 2.21-4.88) were more likely to have a successful treatment than control group. In the case of providing proper training on the use of pediculicides and observing hygiene tips to patients with pediculosis, could help to successful treatment of pediculosis.

Scabies in infants and children - a narrative review.

Scabies is a human ectoparasitosis caused by Sarcoptes scabei var. hominis. World-wide around 300 million patients are affected. Infants and children have the highest incidence rates. Poverty and overcrowding are social factors contributing to a higher risk of transmission and treatment failure. The leading symptom of the infestation is itch. Complications are bacterial infections that are responsible for mortality. Diagnosis is clinical. Non-invasive imaging technologies like dermoscopy can be used. Polymerase chain reaction (PCR) is less sensitive and specific than microscopy of skin scrapings. Treatment of choice is topical permethrin 5%. Ivermectin is the only oral drug FDA-approved for scabies. It should be used in cases non-responsive to topical therapy and in case of high number of infested patients in addition to topical therapy. Pseudo-resistance to treatment is not uncommon. New drugs are on the horizon. What is Known: • Pruritus is the leading symptom causing sleep disturbances and scratching with the risk of secondary bacterial infections. • Treatment failure is related to inappropriate application of topical drugs and asymptomatic family members. What is New: • COVID-19 pandemic and migration are contributing to an increased incidence of scabies. • New compounds to treat scabies are on the horizon.

Scratching beneath the surface: An evaluation of the management of scabies 2017-2023.

INTRODUCTION: Possible resistance to recommended treatments for scabies has emerged recently. In response to anecdotal reports of a recent increase in treatment failure with permethrin, the British Association for Sexual Health and HIV (BASHH) released a statement alerting members to this. AIMS: To examine attendances and the treatment pathways for scabies cases seen at local sexual health clinics. METHODOLOGY: A case note review of scabies attendances between January 2017 and December 2023 was conducted. Data collected included patient demographics, clinical information, and scabies treatment histories. Statistical analysis was performed. RESULTS: 143 patients attended with scabies. The number of scabies cases did not appear to increase significantly from 2017 to 2023 (p = .09). There was significant increase in median number of treatments per case per year over time (p = .013). The number of individuals needing second-line treatments increased significantly over time (p-trend < 0.001). DISCUSSION: Individuals with scabies are requiring more treatments to clear infection. Use of ivermectin has risen in the last year suggesting that second-line treatment is increasingly needed for eradication. Whilst treatment failure may be due to non-compliance with treatment and decontamination efforts for both index and contacts, the more recent change in findings could be attributed to a fall in permethrin efficacy.

Crusted Scabies in a Pediatric Liver Transplant Recipient on Immunosuppression.

BACKGROUND Crusted scabies is a severe skin infection resulting from hyper-infestation with the obligate parasite Sarcoptes scabiei var. hominis. In contrast to classic scabies, crusted scabies may involve as many as hundreds to millions of mites. Importantly, this condition is associated with a mortality rate of 60% in 5 years, and is more likely to develop in immunosuppressed hosts, presumably due to an impaired T-cell response against the mite. CASE REPORT We present a case of crusted scabies in a 13-year-old girl during her early post-liver transplant period receiving immunosuppression successfully treated with topical 5% permethrin. She had pruritic erythematous papules, confirmed as scabies through skin scraping. The challenge of misdiagnosis during the initial presentation is noteworthy, given atypical manifestations and more common differentials. To our knowledge, only 2 cases of crusted scabies in pediatric solid-organ transplant recipients have been reported. Despite the absence of guidelines for pediatric solid-organ transplant recipients, urgent treatment is required due to the high associated mortality rates. In our case, early treatment proved successful without any secondary bacterial infections or clinical evidence of relapse during a 6-month follow-up. CONCLUSIONS We report a case of scabies in a pediatric liver transplant recipient that was successfully treated. It is crucial to consider the diagnosis of scabies given the associated morbidity and the risk of secondary bacterial infections among other more common differentials. Notably, the response to standard anti-scabies treatment may lead to resolution without relapse in pediatric solid-organ transplant recipients.

National survey in Switzerland calls for improved diagnosis and treatment in children with scabies.

AIM OF THE STUDY: The global prevalence of scabies is estimated to be up to 200 million cases annually, with young children particularly affected. In Europe, most cases are thought to originate in migrant populations. Scabies management is challenging in children. To identify knowledge gaps and research needs, we aimed to descriptively evaluate the management of children with scabies by different Swiss healthcare providers. METHODS: An invitation for an anonymous online survey (36 questions) was sent to members of Swiss societies of dermatologists, general practitioners, paediatricians, paediatric dermatologists, paediatric infectious diseases specialists, and tropical medicine specialists, inviting clinicians to participate from 25th May to 8th August 2020. One reminder invitation was sent. Hospital pharmacies and the distributor of permethrin were contacted to report consumption trends of scabicides in 2018 and 2019. RESULTS: The survey was completed by 248 clinicians: 146 (59%) paediatricians, 47 (19%) dermatologists, 28 (11%) general practitioners, 6 (2%) paediatric dermatologists, 13 (5%) paediatric infectious diseases specialists, and 8 (3%) tropical medicine specialists. Most consulted up to 10 scabies cases within a 16-month period, with similar numbers in migrant and Swiss children. Dermoscopy was used by 24% of non-dermatologists. Non-dermatologists did not consider co-treatment of close contacts in up to 59% of cases. While permethrin was the first-line treatment, treatment failures were frequently reported in children aged <5 years. Up to 67% of paediatric dermatologists regularly used oral ivermectin off-label in children weighing <15 kg. None of the paediatric dermatologists, 15% of the dermatologists, and 9% of the non-dermatologists used only one treatment cycle.Scabicide consumption increased. Treatment studies on ivermectin use in children weighing <15 kg had the highest research priority. CONCLUSION: In Switzerland, scabies is a frequent dermatosis in migrant and Swiss children. While accessible, optimal diagnostics are underutilised, and treatment is suboptimal. Permethrin resistance appears to be an increasing problem. Dermatologists regularly use ivermectin off-label in children weighing <15 kg. Treatment studies on ivermectin use in children weighing <15 kg, user-friendly diagnostic tools, new treatment protocols, and child-friendly dosage forms are needed to improve the diagnosis and treatment of children with scabies.

Escabiosis: lesiones pruriginosas altamente contagiosas / Scabies: highly contagious pruritic lesions

La escabiosis es una infestación producida por Sarcoptes scabiei, caracterizada por lesiones generalizadas pruriginosas. El diagnóstico es eminentemente clínico. Síntomas compatibles en varios miembros de la misma familia se consideran diagnósticos. El tratamiento consiste en la aplicación de Permetrina al 5% en la superficie cutánea.

Scabies is an infestation produced by Sarcoptes scabiei. Itchy generalized lesions characterized this pathology. The diagnosis is clinical. Compatible symptons presented in some members of the same family are considered diagnostic. The treatment is based in the application of Permetrine 5% in all the cutaneous area.

Crusted scabies due to indiscriminate use of glucocorticoid therapy in infant

Abstract Crusted or Norwegian scabies is a parasitic infectious disease caused by Sarcoptes scabiei var. hominis that mainly affects immunocompromised individuals and those with neurological patients. We report a case of crusted scabies in a 4-month-old infant who had been treated erroneously for atopic dermatitis with high doses of corticosteroids. This initial misdiagnosis associated with the abusive use of corticosteroid facilitated the evolution of scabies to crusted scabies and its main complications of secondary infection and sepsis.

Manejo en atención primaria de escabiosis en una familia con ruralidad extrema / Primary care management of scabies in a family with extreme rurality

La dermatoparasitosis producida por el acaro Sarcoptes scabiei variedad hominis, presenta una distribución poblacional relacionada al hacinamiento, condiciones higiénicas deficientes, pobreza y características geoclimáticas. El contagio ocurre de forma directa cutánea o a través de fómites. Liquiñe,poblado fronterizo de la Región de los Ríos, Chile, presenta en gran parte de su población las características mencionadas, con difícil acceso a comunicación digital y derivación médica. La incidencia de sarna se ve modificada al realizar intervenciones educacionales y saneamiento local, tanto como el diagnostico precoz y el tratamiento oportuno logran una modificación sustancial de la prevalencia. Se presenta el reporte de un caso. Paciente sexo femenino, 33 años, que presenta lesiones por grataje, excoriadas, con pápulo-pústulas de dos años de evolución, con manejo inicial sintomático por diagnóstico de dermatitis y psoriasis sin mejora de las lesiones. Conjuntamente se identifica en la hija de 4 años, lesiones primarias de características similares a las iniciales. Las lesiones de la menor se presentan como vesículas en espacio interdigital, muñe-cas, región periumbilical y surco acarino, compatibles con sarna. Se inicia tratamiento tópico permetrina 5 %a toda la familia, basados en las recomendaciones de la guía de manejo MINSAL. Se logra tras 2 años de evolución regresión total de los signos y síntomas a los 2 meses de iniciada la terapia. La presente revisión de caso pretende reforzar las ideas de diagnóstico precoz, tanto de caso índice como de probables contactos,educación continua a la comunidad. Tratamiento efectivo y oportuno, adecuado a la realidad socio cultural década localidad, tomando en cuenta factores de riesgos para la presentación y el abandono de la terapia. Asimismo promover las redes institucionales para la distribución de tratamiento, asesoramiento por especialistas y conocimientos actualizados de la semiología de cada cuadro dermatológico por el médico general.

The dermato parasitosis producedby the Sarcoptes scabiei mite hominis variety, has apopulation distribution related to over crowding, poor sanitation, poverty and geo-climatic characteristics.Transmission occurs directly through skin or fomites.In the border town of Liquiñe in the Region de los Rios,Chile, a substantial amount of the population is subject to the above characteristics, with difficult access to digital communication and medical referrals. The incidence of scabies is modified through educational interventions, and local sanitation, as well as early diag-nosis and timely treatment thus achieving a substantial change in prevalence. A case report is presented. Female patient, 33 years old presents with excoriated crusted lesions, with papules and pustules following two years of development, initial symptomatic management diagnosis of psoriasis and dermatitis,showed no improvement of the lesions. At the same time the 4 year old daughter of the patient presented with primary lesions similar to baseline characteristics.The child ́s lesions presented as vesicles in interdigital space, wrists, periumbilical region and mite grooves compatible with scabies. Permethrin 5% topical treatment was prescribed for the whole family, basedon the recommendations of the MINSAL guide management is initiated. At 2 months of treatment therapy on set, complete recovery was achieved following two years of evolution of signs and symptoms.This case review aims to reinforce the ideas of earlydiagnosis, in both probable index case and contact,and continuing education in the community. Effective and timely treatment, in conjunction with the socio-cultural reality of each community, taking into account risk factors, such as seeking medical treatment and abandoning therapy. Furthermore, it is also intended to promote institutional networks for treatment dissemination, counseling by specialists and updated information for each dermatological presentation for the general medicine physician.

Cromatografia líquida de alta eficiência aplicada ao controle da qualidade de cis-permetrina em loção capilar / High-performance liquid chromatography applied to the control of the quality of cis-permethrin in capillary lotion

Doenças ectoparasitárias como a escabiose, a pediculose, a tungíase e a larva migrans cutânea são epidêmicas em inúmeras comunidades carentes no Brasil e seu controle efetivo é um desafio para a Saúde Pública. Embora a permetrina seja um dos medicamentos aprovados pelo Food and Drug Administration para o tratamento da pediculose, não há um método oficial disponível para a realização do controle da qualidade deste produto em loção capilar de uso humano. Assim, o objetivo deste trabalho foi desenvolver e validar um método analítico sensível, específico, preciso e exato para esta análise, seguindo os critérios descritos na Resolução no 899/2003 da Agência Nacional de Vigilância Sanitária (ANVISA). A cromatografia líquida de alta eficiência (HPLC) com detector diode array (λ = 235nm) foi empregada na determinação de cis-permetrina em loção capilar, visando implementar um sistema de controle da qualidade em laboratórios analíticos. A cis-permetrina e a substância utilizada como padrão interno (PI), o cloridrato de nafazolina, foram separados em coluna analítica S5W (4,6 x 150mm) Waters Spherisorb® e eluídos isocraticamente (fluxo de 1,2mL/min). A cis-permetrina e o PI foram caracterizados pelos tempos de retenção de 1,52 e 8,66 minutos respectivamente. O método mostrou-se linear na faixa de 1,6 a 127,5µg/mL e, nos estudos de precisão intra e interensaio, foram obtidos coeficientes de variação inferiores a 5%, calculados a partir dos resultados. A exatidão média do método foi de 103%. Os limites de detecção e quantificação foram 1,6µg/mL e 2,4µg/mL respectivamente. A cis-permetrina manteve-se estável por 24 horas à temperatura ambiente; por 15 dias a 4ºC e 30 dias a -20ºC. O método mostrou-se simples e apropriado para a determinação de cis-permetrina em loção capilar.

Parasitic skin diseases such as scabies, pediculosis, tungiasis, and cutaneous larva migrans are epidemic in numerous communities in Brazil and their effective control is a major challenge to public health. Permethrim is one of the medications approved by the Food and Drug Administration to treat pediculosis. However, official methods of quality control for permethrin's use as hair lotion are currently unavailable. Thus, a specific and accurate method was validated using high performance liquid chromatography (HPLC) with a diode array detector (λ = 235 nm) in order to determine cis-permethrin in hair lotion, aiming to establish a systemof quality control in analytical laboratories. Cis-permethrin and naphazolinechloride (internal standard - IS) were separated in an analytical S5W column (4.6 x 150 mm) Waters Spherisorb® and isocratically eluted (flow rate =1.2 mL/min). Cis-permethrin and IS were characterized by their retention times: 1.52 and 8.66 minutes, respectively. The accuracy of this method was 103%. A linear range was detected from 1.6 to 127.5µg/ml and CV < 5% calculated from intra and inter-essay precision results. LOD and LOQ were 1.6µg/mL and 2.4µg/mL, respectively. Cis-permethrin remained stable for 24 hours at room temperature; for 15 days at 4ºC and 30 days at -20ºC. The method was considered simple and suitable for determination of cis-permethrin in hair lotion.

Forma de aplicación y efectividad de la Permetrina 1 por ciento, utilizada por convivientes con escolares, para el control de la pediculosis capitis en los niños / Ways of application and effectiveness of 1 permethrin used by schoolchildren relatives for the control of pediculosis capitis

Introducción: entre los problemas que inciden en los fallos, de los tratamientos pediculicidas, están la forma de aplicación y la baja efectividad de los productos utilizados. Objetivos: conocer, por medio de encuestas de opiniones, la forma de aplicación y la efectividad de la Permetrina 1 por ciento fabricada en Cuba para el control de los piojos. Métodos: los cuestionarios se distribuyeron entre los convivientes con escolares de primaria, que con anterioridad habían utilizado el producto en los niños. El trabajo se realizó de mayo a julio de 2007 en escuelas urbanas y rural-urbanas de las provincias Ciudad de La Habana, Sancti Spíritus y Las Tunas, en Cuba. Resultados: de 786 convivientes encuestados, 637 (81,17 por ciento) no aplicaron el pediculicida según las indicaciones formuladas en el prospecto, que se adjunta al frasco, 579 (73,66 por ciento) la consideran ineficaz y solo 143 (16,32 por ciento) la han utilizado como único tratamiento. Conclusiones: no existe sincronización en los pasos seguidos durante el tratamiento. Se evidencia una alta heterogeneidad en las respuestas, porque más de 70 por ciento de los encuestados la consideran ineficaz para el tratamiento de la pediculosis capitis.

Background: Among the problems that influence on failure of pediculosis treatment is the way of application and low effectiveness of used products. Objectives: to find out, through surveys, the ways of application and the effectiveness of 1 percent permethrin manufactured in Cuba for the control of pediculosis capitis. Methods: the questionnaires were distributed among people living with elementary schoolchildren, who had previously applied the products to children. The study was performed from May to July 2007 in urban and rural-urban schools located in City of Havana, Sancti Spiritus and Las Tunas provinces in Cuba. Results: Seven hundred and eighty six people were surveyed, 637 of them (81,17 percent) did not follow the instructions given in the flask in applying the anti-pediculosis products, 579 (73,66 percent) considered it as ineffective and only 143 (16,32 percent) had used it as unique treatment. Conclusions: there is not any agreement in steps followed by these people during treatment. Responses were very heterogeneous because over 70 of surveyed persons stated that permethrin was ineffective for treatment of pediculosis capitis.

Brote de sarna en un hospital terciario a partir de un caso de sarna costrosa / An outbreak of scabies in a tertiary-care hospital from a crusted scabies case

Realizamos el estudio epidemiológico de un brote de sarna ocurrido en un hospital terciario, a partir de un caso de sarna costrosa, en febrero de 2005. Detectamos diez casos secundarios; ocho en el personal de salud y dos en pacientes hospitalizados, con una tasa de ataque de 4,1 por ciento. A diferencia de otros brotes, el diagnóstico de sarna costrosa se hizo al ingreso del caso primario al hospital. Las causas del brote fueron: adherencia deficiente a las medidas de aislamiento de contacto, permanencia prolongada del caso primario en sala compartida, y retardo en el inicio del tratamiento específico. Las principales medidas de control fueron: alertar a los servicios sobre el brote, realizar vigilancia epidemiológica, coordinación con la Dirección del Hospital y el Departamento de Salud Ocupacional, capacitar al personal de salud en las medidas de control, instaurar medidas de aislamiento y tratar a los casos y sus contactos con permetrina 5 por ciento loción tópica.

In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1 percent. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5 percent permethrin topical lotion.

Pediculosis hasta 2008 / Pediculosis until 2008

La pediculosis es una patología cuya prevalencia está en aumento en todo el mundo. En parte, esto se debe a las dificultades que presentan los tratamientos disponibles. Los pediculicidas químicos usados actualmente son piretrinas (permetrina 1% es la más usada), malatión 0,5%, lindano 1% (cuestionado debido a su neurotoxicidad e impacto ambiental) e ivermectina (sin aprobación de la Food and Drug Administration). Si bien existe una creciente evidencia sobre el desarrollo de resistencia a estos pediculicidas, es importante considerar la correcta realización de los tratamientos o la presencia de una reinfección antes que el desarrollo de resistencia propiamente dicho, razón por la cual es recomendable que el problema sea abordado en forma conjunta por el equipo de salud, la escuela y la familia. Actualmente se investigan nuevas opciones terapéuticas más seguras y eficaces como, por ejemplo, métodos físicos, aceites esenciales y derivados vegetales, nuevos insecticidas o la incorporación formal de opciones como la ivermectina, para lo cual aún se requiere más investigación que aporte evidencia de mejor calidad metodológica.

Head lice is a condition whose prevalence is increasing worldwide, probably because of the difficulties that available treatments present. Chemicals pediculicides currently in use are pyrethrins (1% permethrin is the most widely used), 0.5% malathion, 1% lindane (questioned because of its neurotoxic effects and their environmental impact) and ivermectin (not yet approved by the Food and Drug Administration). While there is increasing evidence of growing development of resistance to these pediculicides, it is important to consider the proper conduct of the treatments or the presence of reinfection before considering the real development of resistance, for these reasons a global assessment that includes the health equipe, the school and the family is desirable. New therapeutic options, both safe and effective, are being investigated. They include physical methods, products derived from essential oils and herbal products, new insecticides and ivermectin, which requires further research to provide evidence of better quality.