Interventions for treating scabies. - GOV.UK

Interventions for treating scabies. From: Foreign, Commonwealth & Development Office Published 1 January 2010 Document Type: Journal Article Theme: Health First published: 1 January 2010

Authors: Johnstone, P. and Strong, M. Contents Abstract Citation Links Abstract

Background Scabies is an intensely itchy parasitic infection of the skin caused bythe Sarcoptes scabiei mite. It is a common public health problem with anestimated global prevalence of 300

million cases. Serious adverseeffects have been reported for some drugs used to treat scabies.

Objectives To evaluate topical and systemic drugs for treating scabies.

Search strategy In June 2010, we searched the Cochrane Infectious Diseases GroupSpecialized Register, CENTRAL (The Cochrane Library 2010, Issue 2),MEDLINE, EMBASE, LILACS, and INDMED. In

August 2010, we also searchedthe grey literature and sources for registered trials. We also checkedthe reference lists of retrieved studies.

Selection criteria Randomized controlled trials of drug treatments for scabies.

Data collection and analysis Two authors independently assessed trial quality and extracted data.Results were presented as risk ratios with 95% confidence intervals anddata combined where

appropriate.

Main results Twenty-two small trials involving 2676 people were included. One trialwas placebo controlled, 18 compared two or more drug treatments, threecompared treatment regimens, and one

compared different drug vehicles.

Fewer treatment failures occurred by day seven with oral ivermectincompared with placebo in one small trial (55 participants). Topicalpermethrin appeared more effective than oral ivermectin

(140participants, 2 trials), topical crotamiton (194 participants, 2trials), and topical lindane (753 participants, 5 trials). Permethrinalso appeared more effective in reducing itch

persistence than eithercrotamiton (94 participants, 1 trial) or lindane (490 participants, 2trials). No difference was detected between permethrin (a syntheticpyrethroid) and a natural

pyrethrin-based topical treatment (40participants, 1 trial), and between permethrin and benzyl benzoate (53participants, 1 trial), however both these trials were small.

No significant difference was detected in the number of treatmentfailures between crotamiton and lindane (100 participants, 1 trial),lindane and sulfur (68 participants, 1 trial), benzyl

benzoate andsulfur (158 participants, 1 trial), and benzyl benzoate and naturalsynergized pyrethrins (240 participants, 1 trial); all were topicaltreatments. No trials of malathion were

identified.

No serious adverse events were reported. A number of trials reportedskin reactions in participants randomized to topical treatments. Therewere occasional reports of headache, abdominal pain,

diarrhoea,vomiting, and hypotension.

Authors' conclusions Topical permethrin appears to be the most effective treatment forscabies. Ivermectin appears to be an effective oral treatment. Moreresearch is needed on the

effectiveness of malathion, particularly whencompared to permethrin, and on the management of scabies in aninstitutional setting and at a community level.

Plain language summary Scabies is a parasitic infection of the skin. It occurs throughout theworld, but is particularly problematic in areas of poor sanitation,overcrowding, and social

disruption, and is endemic in manyresource-poor countries. The global prevalence of scabies is estimatedat 300 million cases, but the level of infection varies betweencountries and

communities. The female mite burrows into the skin to layeggs which then hatch out and multiply. The infection can spread fromperson to person via direct skin contact, including sexual

contact. Itcauses intense itching with eruptions on the skin. Various drugs havebeen developed to treat scabies, and herbal and traditional medicinesare also used. The review of trials

attempted to cover all these. Theauthors identified 22 small trials involving 2676 people, with 19 of thetrials taking place in resource-poor countries. Permethrin appeared tobe the most

effective topical treatment for scabies, and ivermectinappeared to be an effective oral treatment. However, ivermectin isunlicensed for this indication in many countries. Adverse events such

asrash, vomiting, and abdominal pain were reported, but the trials weretoo small to properly assess serious but rare potential adverse effects.No trials of herbal or traditional medicines

were identified forinclusion.

Strong, M.; Johnstone, P. Interventions for treating scabies. Cochrane Database of Systematic Reviews (2007) (Issue 3) Art. No.: CD000320. [DOI: 10.1002/14651858.CD000320.pub2]

Interventions for treating scabies.

Updates to this page Published 1 January 2010 Contents Explore the topic International aid and development