Scabies treatment

Crotamiton (Eurax) is available as a cream or lotion. Suggested guidelines for scabies treatment call for two applications to the entire body from the chin down at 24-hour intervals, with a cleansing bath 48 hours after the last application. Crotamiton is an effective agent that can be used as an alternative to lindane. Allergic contact hypersensitivity and primary irritation may occur, necessitating discontinuance of therapy. Application to acutely inflamed skin or to the eyes or mucous membranes should be avoided. 

MAJOR USES Used as an insecticide on field crops, com, wheat, pasture, forestry, livestock and viticulture used as a medication (pediculicide, scabicide, ectoparasiticide and lice and scabies treatment). 

The agent of choice for scabies is permerthrin 5% (Elimite) cream. Alternative agents in subjects who cannot use permethrin are crotamiton 10% (Eurax) and oral ivermectin (Stromectal) 200 mcg/kg as a single dose. To initiate the treatment with permerthrin, the skin should be scrubbed in a warm soapy bath to remove the scabs. The permerthrin lotion should then be applied to the whole body, avoiding the face, mucous membranes, and eyes, and left on for 8 to 14 hours. A single application eradicates 97% of scabies. All close contacts should be treated appropriately. The pruritus associated with scabies may persist for 2 to 4 weeks because of the remnants of mite parts in the skin. 

In Ayurvedic medicine, coconut oil infused with herbs has been used medicinally for almost 4000 years as an effective treatment for skin diseases caused by infestation with parasites, such as scabies and head lice. Today, about 20 billion coconuts are grown each year, and although the major producers are the Philippines, India, and Indonesia, virtually everywhere the coconut palm grows — in the tropical regions of Latin America and East Africa, as well as Asia, the Pacific Islands, and the Philippines — coconut products serve as a dietary staple. ... 

Malathion is an organophosphate cholinesterase inhibitor. Up to 8% of the topically applied dose may be absorbed. Malathion is used as a treatment for head lice, body lice and scabies. It effectively kills both the eggs and the adult lice. Malathion is an insecticide of relatively low human toxicity. However if malathion is used in an indoor environment, as it breaks down into malaoxon, it can be seriously and chronically poisonous. The safety of malathion in pregnancy and in lactating women and in children has not been established. 

Post-streptococcal glomerulonephritis is the result of infection with the nephritogenic strain of group A hemolytic streptococci. The streptococci are usually isolated from patients with a sore throat and, in developing countries, skin infection like impetigo or infected scabies is an important cause. There is no specific treatment except for antihypertensives, salt restriction and diuretics. Corticosteroids are of no value. The disease is self-limiting but, in some adults, it may progress to chronic renal failure. 

Scakies PO 200 mcg/kg as a single dose and repeat 2 wk later Norwegian Scabies (crusted scabies infection), superinfected scabies, or resistant scabies PO 200 mcg/kg with repeated treatments or combined with a topical scabicide Pediculosis PO A regimen of 2 doses of 200 mcg/kg with each dose separated by 10 days... 

Scabies Topical Apply from head to feet, leave on for 8-14 hr. Wash with soap and water. Repeat application if living mites present 14 days after initial treatment. 

It is recommended that permethrin 1% cream rinse (Nix) be applied undiluted to affected areas of pediculosis for 10 minutes and then rinsed off with warm water. For the treatment of scabies, a single application of 5% cream (Elimite) is applied to the body from the neck down, left on for 8-14 hours, and then washed off. Adverse reactions to permethrin include transient burning, stinging, and pruritus. Cross-sensitization to pyrethrins or chrysanthemums has been alleged but inadequately documented. 

Recent concerns about the toxicity of lindane have altered treatment guidelines for its use in scabies the current recommendation calls for a single application to the entire body from the neck down, left on for 8-12 hours, and then washed off. Patients should be retreated only if active mites can be demonstrated, and never within 1 week of initial treatment. 

Elgart ML A risk-benefit assessment of agents used in the treatment of scabies. Drug Saf 1996 14 386. [PMID 8828016]... 

Several hydroxylated and methoxylated acronycine analogues were isolated from Citrus depressa (Rutaceae), a Chinese drug Chen-pi used for treating heartache, abdominal pain, diarrhoea, tussis, vomiting, inappetence, and as an expectorant, and from Glycosmis citrifolia (Willd.) Lindl. (G. cochinchinensis Pierre), a wild shrub used in the treatment of scabies, boils and ulcers [289-291]. None of these compounds was reported to possess antineoplastic activity. 

Pokeweed has various traditional uses, from medicinal to industrial processes. It is used as a cathartic, emetic, narcotic, and gargle. Additional medicinal uses include treatment of various skin diseases, conjunctivitis, syphilis, cancer, parasitic infestations of the scalp, chronic rheumatism, ringworm, dyspepsia, swollen glands, scabies, ulcers, edema, dysmenorrhea, mumps, and tonsillitis. It is currently popular for its antimicrobial and antineoplastic activity. 

Lindane (Kwell, etc) is available as a shampoo or lotion. For pediculosis capitis or pubis, one application of 30 mL of shampoo is worked into a lather and left on the scalp or genital area for 5 minutes and then rinsed off. No additional application is indicated unless living lice are present 1 week after treatment. Then reapplication may be required. Recent concerns about the toxicity of lindane have altered treatment guidelines for its use in scabies the current recommendation calls for a single application to the entire body from the neck down, left on for 8-12 hours, and then washed off. Patients should be retreated only if active mites can be demonstrated, and never within 1 week of initial treatment. 

Uses Thiram is a dimethyl dithiocarbamate compound and appears as a white to yellow crystalline powder with a characteristic odor. Thiram is used to prevent crop damage in the field and to protect harvested crops from deterioration in storage or transport. Thiram also is used as a seed protectant and to protect fruits, vegetables, ornamentals, and turf crops from a variety of fungal diseases. In addition, it is used as an animal repellent to protect fruit trees and ornamentals from damage by rabbits, rodents, and deer. Thiram is available as dust, flowable, wettable powder, water-dispersible granules, water suspension formulations, and in mixtures with other fungicides. Thiram has been used in the treatment of human scabies, as a sunscreen, and as a bactericide applied directly to the skin or incorporated into soap.17,50,52... 

Gastrointestinal Effects. Vomiting occurred soon after application of a salve made up of potassium chromate to the skin of an unspecified number of individuals for the treatment of scabies. Some of these individuals died as a result of infection of the exposed area, and autopsy revealed hyperemia of the gastric mucosa (Brieger 1920). 

Anise leaves are used to treat digestive problems and to relieve toothache, and its essential oil is used to treat lice and scabies. In aromatherapy, aniseed essential oil is used to treat colds and flu. It is also being researched for the treatment of bird flu (Waumans et al., 2006). 

The volatile oil in aniseed provides the basis for its internal use to ease griping, intestinal colic and flatulence. It also has a marked expectorant and antispasmodic action and may be used in bronchitis and in tracheitis, where there is persistent irritable coughing, and to reduce the symptoms of whooping cough. Externally, the oil may be used in an ointment base for the treatment of scabies and lice infestations. Aniseed s mild oestrogenic effects, thought... 

Chew A-L, Bashir S T, Maibach H12000 Treatment of head lice. Lancet 356 523-524 Chosidow O 2000 Scabies and pediculosis. Lancet 355 819-825... 

Sulfiram is similar in structure to disulfiram, but has one less sulfur atom in its central chain. It is a much weaker inhibitor of aldehyde dehydrogenase than disulfiram and is used in the topical treatment of scabies. 

Ivermectin, a dihydroavermectin Bl, is an effective microfilaricide used in the treatment of strongyloides, scabies, and aU types of filariasis except Dipalonema (Mansonelta) perstans infections. 

In 80 children aged 6 months to 14 years a single dose of ivermectin 200 micrograms/kg was compared with topical benzyl benzoate for the treatment of pediatric scabies in a randomized, controlled trial (17). Ivermectin cured 24 of 43 patients and topical benzyl benzoate cured 19 of 37 patients at 3 weeks after treatment. There were no serious adverse effects with either treatment, although benzyl benzoate was more likely to produce local skin reactions. These results are in line with those of another study, in which 18 children aged 14 months to 17 years with either scabies (n — 11) or cutaneous larva migrans (n — 7) were... 

A puzzling reaction was recorded in a small hospitalized Canadian population of elderly subjects treated for scabies with a single dose of ivermectin (150-200 micrograms/kg). Within 6 months, 15 of the 47 patients had died. All those who died had developed a sudden change in behavior, with lethargy, anorexia, and listlessness before death (31). The effect may have been an artefact with some extraneous cause, and it is notable that other groups using this treatment for scabies have not recorded similar reactions. 

Barkwell R, Shields S. Deaths associated with ivermectin treatment of scabies. Lancet 1997 349(9059) 1144-5. 

Lindane is a pesticide that is widely used in the treatment of scabies and pediculosis, usually in a 1 % lotion (SEDA-5, 154) (1-4). It is the gamma-isomer of 1,2,3,4,5,6-hexachlorocyclohexane. The hazards of excessive industrial exposure and accidental ingestion have been well documented (3). 

Shacter B. Treatment of scabies and pediculosis with lindane preparations an evalnation. J Am Acad Dermatol 1981 5(5) 517-27. 

Lee B, Groth P. Scabies transcutaneous poisoning during treatment. Pediatrics 1977 59(4) 643. 

However, the most widespread pharmaceutical use of benzyl benzoate is as a topical therapeutic agent in the treatment of scabies. Benzyl benzoate is also used therapeutically as a parasiticide in veterinary medicine. " ... 

Benzyl benzoate is widely used as a 25% v/v topical application in the treatment of scabies and as an excipient in intramuscular injections and oral products. Adverse reactions to benzyl benzoate include skin irritation and hypersensitivity reactions. Oral ingestion may cause harmful stimulation of the CNS and convulsions. 

Crotamiton is available in 10% concentration in a lotion and a cream intended for the topical treatment of scabies. Its aniipniriiic effect is probably due to a local anesthetic action. 

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