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Treatment of Scabies

Itch mite Sarcoptes scabiei

Itch mite Sarcoptes scabiei

Scabies is highly contagious skin disease caused by infestation of mite known as Sarcoptes scabiei. Mode of transmission is direct skin-to-skin contact, (hence scabies can be considered as sexually transmitted disease, because it can be transmitted from one sexual partner to another during sexual act due to direct skin-to-skin contact). The most common and troublesome symptom of scabies is consistent itching on the affected area. Other common symptoms of scabies include skin rash, blisters etc.

Treatment of scabies:

Treatment of scabies is by topical or oral use of drugs that can kill the causative agent i.e. Sarcoptes scabiei.

For treatment of scabies the only orally effective drug is ivermectin (this is effective against pediculosis also). Ivermectin can be used for treatment of scabies at the dose of 200 microgram per kilogram of body weight as a single dose and repeated after 2-3 weeks if required. Ivermectin is not approved by USFDA for use for treatment of scabies, due to common and potentially serious side effects.

Topical medications used for treatment scabies include, permethrin (most commonly used and most effective), lindane, sulfur ointment (not approved by USFDA), benzyl benzoate, crotamiton, etc.

Permethrin in treatment of scabies:

If applied properly, permethrin is 100% effective in treatment of scabies. Permethrin is more effective in treatment of scabies than other drugs used for same purpose, as shown in several clinical trials. Commonly single application is sufficient. Apply permethrin cream, all over the body except face and head and wash of after 10-12 hours. Commonly it is applied before bedtime and washed off next morning. Permethrin is the drug of choice for treatment of scabies.

Lindane in treatment of scabies:

It is also known as BHC or gamma benzene hexachloride. Cure rate is 84% to 92% for scabies. Less effective than permethrin. Cream/lotion is applied all over the body except face and head and wash of after 12-24 hours. Usually single application is sufficient. May be repeated after a week. Scabies mites may develop resistance to lindane. It can be combined with benzyl benzoate to improve efficacy to almost 100% and to prevent development of resistance. Lindane shold not be used in pregnant women and nursing mothers as well as in elderly with skin sore. Lindane is second line drug and should be used only, when permethrin can not used for some reason.

Benzyl benzoate in treatment of scabies:

It is an effective drug for treatment of scabies. The emulsion of benzyl benzoate is applied all over the body except face and head after cleansing bath and a second application is done the next day than washed off after 24 hours. Benzyl benzoate has aromatic smell and do not interfere with routine activity. Have minimal side effects, as penetration through skin is minimal.

Other drugs such as crotamiton, sulfur ointment etc. are used less commonly, because highly effective and non-toxic drugs are available. For symptomatic relief or itching antihistamines are used.

It may take few days for scabies to subside after treatment. If treated with appropriate drug cure is certain, if there is no cure after appropriate treatment, the diagnosis of scabies should be questioned.

Image source: http://healthyone.org/wp-content/uploads/2013/08/FileSarcoptes_scabei_2.jpg

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