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Interventions for treating scabies - PubMed

  • ️Mon Jan 01 2007

Review

Interventions for treating scabies

M Strong et al. Cochrane Database Syst Rev. 2007.

Abstract

Background: Scabies is an intensely itchy parasitic infection of the skin caused by the Sarcoptes scabiei mite. It is a common public health problem with an estimated global prevalence of 300 million cases. Serious adverse effects have been reported for some drugs used to treat scabies.

Objectives: To evaluate topical and systemic drugs for treating scabies.

Search strategy: In February 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE, EMBASE, LILACS, and INDMED. In March 2007, we also searched the grey literature and sources for registered trials. We also checked the 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 relative risks with 95% confidence intervals and data combined where appropriate.

Main results: Twenty small trials involving 2392 people were included. One trial was placebo controlled, 16 compared two or more drug treatments, two compared treatment regimens, and one compared different drug vehicles.Fewer treatment failures occurred by day seven with oral ivermectin in one small trial (55 participants). Topical permethrin appeared more effective than oral ivermectin (85 participants, 1 trial), topical crotamiton (194 participants, 2 trials), and topical lindane (753 participants, 5 trials). Permethrin also appeared more effective in reducing itch persistence than either crotamiton (94 participants, 1 trial) or lindane (490 participants, 2 trials). One small trial did not detect a difference between permethrin (a synthetic pyrethroid) and a natural pyrethrin-based topical treatment (40 participants). No significant difference was detected in the number of treatment failures between crotamiton and lindane (100 participants, 1 trial), lindane and sulfur (68 participants, 1 trial), benzyl benzoate and sulfur (158 participants, 1 trial), and benzyl benzoate and natural synergized pyrethrins (240 participants, 1 trial); all were topical treatments. No trials of malathion were identified. No serious adverse events were reported. A number of trials reported skin reactions in participants randomized to topical treatments. There were occasional reports of headache, abdominal pain, diarrhoea, vomiting, and hypotension.

Authors' conclusions: Topical permethrin appears to be the most effective treatment for scabies. Ivermectin appears to be an effective oral treatment. More research is needed on the effectiveness of malathion, particularly when compared to permethrin, and on the management of scabies in an institutional setting and at a community level.

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Conflict of interest statement

None known.

Figures

1
1

Forest plot of comparison: 1 Ivermectin versus placebo, outcome: 1.1 Treatment failure in clinically diagnosed cases.

2
2

Forest plot of comparison: 2 Ivermectin versus permethrin, outcome: 2.1 Treatment failure in clinically diagnosed cases.

3
3

Forest plot of comparison: 3 Ivermectin versus lindane, outcome: 3.1 Treatment failure in clinically diagnosed cases.

4
4

Forest plot of comparison: 4 Ivermectin versus benzyl benzoate, outcome: 4.1 Treatment failure in clinically diagnosed cases.

5
5

Forest plot of comparison: 4 Ivermectin versus benzyl benzoate, outcome: 4.2 Itch persistence.

6
6

Forest plot of comparison: 5 Permethrin versus crotamiton, outcome: 5.1 Treatment failure in clinically diagnosed cases.

7
7

Forest plot of comparison: 5 Permethrin versus crotamiton, outcome: 5.2 Treatment failure in microscopically diagnosed cases.

8
8

Forest plot of comparison: 5 Permethrin versus crotamiton, outcome: 5.3 Itch persistence.

9
9

Forest plot of comparison: 6 Permethrin versus lindane, outcome: 6.1 Treatment failure in clinically diagnosed cases.

10
10

Forest plot of comparison: 6 Permethrin versus lindane, outcome: 6.2 Treatment failure in microscopically diagnosed cases.

11
11

Forest plot of comparison: 6 Permethrin versus lindane, outcome: 6.3 Itch persistence.

12
12

Forest plot of comparison: 7 Permethrin versus benzyl benzoate, outcome: 7.1 Treatment failure in clinically diagnosed cases.

13
13

Forest plot of comparison: 8 Permethrin versus natural synergized pyrethrins, outcome: 8.1 Itch persistence.

14
14

Forest plot of comparison: 9 Crotamiton versus lindane, outcome: 9.1 Treatment failure in clinically diagnosed cases.

15
15

Forest plot of comparison: 9 Crotamiton versus lindane, outcome: 9.2 Treatment failure in microscopically diagnosed cases.

16
16

Forest plot of comparison: 10 Lindane versus sulfur, outcome: 10.1 Treatment failure in clinically diagnosed cases.

17
17

Forest plot of comparison: 10 Lindane versus sulfur, outcome: 10.2 Itch persistence.

18
18

Forest plot of comparison: 11 Benzyl benzoate versus sulfur, outcome: 11.1 Treatment failure in clinically diagnosed cases.

19
19

Forest plot of comparison: 12 Benzyl benzoate versus natural synergized pyrethrins, outcome: 12.1 Treatment failure in clinically diagnosed cases.

20
20

Forest plot of comparison: 12 Benzyl benzoate versus natural synergized pyrethrins, outcome: 12.2 Treatment failure in microscopically diagnosed cases.

21
21

Forest plot of comparison: 12 Benzyl benzoate versus natural synergized pyrethrins, outcome: 12.3 Itch persistence.

22
22

Forest plot of comparison: 13 Benzyl benzoate: one application versus two applications, outcome: 13.1 Treatment failure in clinically diagnosed cases.

23
23

Forest plot of comparison: 14 Lindane: short application versus long application, outcome: 14.1 Itch persistence.

24
24

Forest plot of comparison: 15 Sulfur: pork fat vehicle versus cold cream vehicle, outcome: 15.1 Treatment failure in clinically diagnosed cases.

1.1
1.1. Analysis

Comparison 1 Ivermectin versus placebo, Outcome 1 Treatment failure in clinically diagnosed cases.

2.1
2.1. Analysis

Comparison 2 Ivermectin versus permethrin, Outcome 1 Treatment failure in clinically diagnosed cases.

3.1
3.1. Analysis

Comparison 3 Ivermectin versus lindane, Outcome 1 Treatment failure in clinically diagnosed cases.

4.1
4.1. Analysis

Comparison 4 Ivermectin versus benzyl benzoate, Outcome 1 Treatment failure in clinically diagnosed cases.

4.2
4.2. Analysis

Comparison 4 Ivermectin versus benzyl benzoate, Outcome 2 Itch persistence.

5.1
5.1. Analysis

Comparison 5 Permethrin versus crotamiton, Outcome 1 Treatment failure in clinically diagnosed cases.

5.2
5.2. Analysis

Comparison 5 Permethrin versus crotamiton, Outcome 2 Treatment failure in microscopically diagnosed cases.

5.3
5.3. Analysis

Comparison 5 Permethrin versus crotamiton, Outcome 3 Itch persistence.

6.1
6.1. Analysis

Comparison 6 Permethrin versus lindane, Outcome 1 Treatment failure in clinically diagnosed cases.

6.2
6.2. Analysis

Comparison 6 Permethrin versus lindane, Outcome 2 Treatment failure in microscopically diagnosed cases.

6.3
6.3. Analysis

Comparison 6 Permethrin versus lindane, Outcome 3 Itch persistence.

7.1
7.1. Analysis

Comparison 7 Permethrin versus benzyl benzoate, Outcome 1 Treatment failure in clinically diagnosed cases.

8.1
8.1. Analysis

Comparison 8 Permethrin versus natural synergized pyrethrins, Outcome 1 Itch persistence.

9.1
9.1. Analysis

Comparison 9 Crotamiton versus lindane, Outcome 1 Treatment failure in clinically diagnosed cases.

9.2
9.2. Analysis

Comparison 9 Crotamiton versus lindane, Outcome 2 Treatment failure in microscopically diagnosed cases.

10.1
10.1. Analysis

Comparison 10 Lindane versus sulfur, Outcome 1 Treatment failure in clinically diagnosed cases.

10.2
10.2. Analysis

Comparison 10 Lindane versus sulfur, Outcome 2 Itch persistence.

11.1
11.1. Analysis

Comparison 11 Benzyl benzoate versus sulfur, Outcome 1 Treatment failure in clinically diagnosed cases.

12.1
12.1. Analysis

Comparison 12 Benzyl benzoate versus natural synergized pyrethrins, Outcome 1 Treatment failure in clinically diagnosed cases.

12.2
12.2. Analysis

Comparison 12 Benzyl benzoate versus natural synergized pyrethrins, Outcome 2 Treatment failure in microscopically diagnosed cases.

12.3
12.3. Analysis

Comparison 12 Benzyl benzoate versus natural synergized pyrethrins, Outcome 3 Itch persistence.

13.1
13.1. Analysis

Comparison 13 Benzyl benzoate: one application versus two applications, Outcome 1 Treatment failure in clinically diagnosed cases.

14.1
14.1. Analysis

Comparison 14 Lindane: short application versus long application, Outcome 1 Itch persistence.

15.1
15.1. Analysis

Comparison 15 Sulfur: pork fat vehicle versus cold cream vehicle, Outcome 1 Treatment failure in clinically diagnosed cases.

Update of

  • Interventions for treating scabies.

    Walker GJ, Johnstone PW. Walker GJ, et al. Cochrane Database Syst Rev. 2000;(3):CD000320. doi: 10.1002/14651858.CD000320. Cochrane Database Syst Rev. 2000. PMID: 10908470 Updated. Review.

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References

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Taplin 1983b {published data only}
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References to ongoing studies

Naeyaert ongoing {unpublished data only}
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References to other published versions of this review

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