Skip to content

Advertisement

  • Correspondence
  • Open Access
  • Open Peer Review

Scabies: an ancient global disease with a need for new therapies

  • 1Email author,
  • 2,
  • 3,
  • 4, 5,
  • 1 and
  • 6
BMC Infectious Diseases201515:250

https://doi.org/10.1186/s12879-015-0983-z

©  Thomas et al. 2015

  • Received: 12 August 2014
  • Accepted: 10 June 2015
  • Published:
Open Peer Review reports

Abstract

Background

Scabies is an ancient disease (documented as far back as 2500 years ago). It affects about 300 million people annually worldwide, and the prevalence is as high as about 60 % in Indigenous and Torres Strait Islander children in Australia. This is more than six times the rate seen in the rest of the developed world. Scabies is frequently complicated by bacterial infection leading to the development of skin sores and other more serious consequences such as septicaemia and chronic heart and kidney diseases. This causes a substantial social and economic burden especially in resource poor communities around the world.

Discussion

Very few treatment options are currently available for the management of scabies infection. In this manuscript we briefly discuss the clinical consequences of scabies and the problems found (studies conducted in Australia) with the currently used topical and oral treatments. Current scabies treatment options are fairly ineffective in preventing treatment relapse, inflammatory skin reactions and associated bacterial skin infections. None have ovicidal, antibacterial, anti-inflammatory and/or anti-pruritic properties. Treatments which are currently available for scabies can be problematic with adverse effects and perhaps of greater concern the risk of treatment failure. The development of new chemical entities is doubtful in the near future. Though there may be potential for immunological control, the development of a vaccine or other immunotherapy modalities may be decades away.

Summary

The emergence of resistance among scabies mites to classical scabicides and ineffectiveness of current treatments (in reducing inflammatory skin reactions and secondary bacterial infections associated with scabies), raise serious concerns regarding current therapy. Treatment adherence difficulties, and safety and efficacy uncertainties in the young and elderly, all signal the need to identify new treatments for scabies.

Keywords

  • Scabies
  • Resistance
  • MDA
  • Ivermectin
  • Permethrin
  • Benzyl peroxide
  • Treatments
  • Indigenous
  • Aboriginal

Background

Scabies has existed for at least 2500 years [1] and currently affects 300 million people annually worldwide. Its listing as a neglected tropical disease by the World Health Organization (WHO) in 2013 [2] recognised the neglect in public and private sector expenditure on this problem, the lack of attention at local, national, and international levels, and the higher incidence of this infection amongst the poor. In Australia it affects about 6 in 10 Aboriginal and Torres Strait Islander children at any given time, more than six times the rate seen in the rest of the developed world [3, 4]. The sequela of scabies predisposes affected children to sepsis and other non-suppurative invasive infections (e.g. lymphadenopathy, acute post-streptococcal glomerulonephritis (APSGN) and rheumatic fever) [5]. Outbreaks of APSGN usually coincide with scabies outbreaks, which can contribute to the development of chronic kidney disease and subsequent renal failure in adulthood [6]. It is usually reported in Australian Aboriginal communities, other Oceanic nations (Papua New Guinea, Fiji, Solomon Islands, Vanuatu) [7], and in some parts of India, Chile and Trinidad [5], and is uncommon outside these communities. APSGN outbreaks do not always coincide with scabies outbreaks elsewhere in the developed world. Scabies infestation has a negative impact on the quality of life for infected individuals (similar to that of psoriasis) resulting in substantial stigmatisation and ostracism [8].

In this manuscript we focus on the challenges found with diagnosis and treatment, emerging resistance among scabies mites, and the need for further research in this field to identify new and alternative therapies for the treatment and prophylaxis of scabies.

Discussion

Diagnosis

At present there is no accurate means of diagnosing scabies in various clinical settings. Presumptive diagnosis is often made on the basis of clinical signs, and a history of contact with other scabies cases [9]. In practice (especially in resource poor settings), identifying scabies mite from patient’s skin is challenging, and a negative result by even experienced clinical staff, does not rule out scabies. A positive response to therapy cannot exclude the spontaneous disappearance of a skin condition other than scabies, and a negative response to the first-line treatment option does not exclude scabies, especially with growing resistance among scabies mites [9]. Recent findings in this field, e.g. serodiagnosis [10] shows promising potential; however, more research is required to evaluate its efficiency in tropical clinical settings.

Treatments

There are several recommended treatment options for scabies and these have been discussed in detail in a 2010 Cochrane review [11]. There are few obvious safe and effective scabicides currently (Table 1 and 2), and treatment effectiveness can vary between clinical settings [12]. So far, there is no international consensus on the appropriate schedule for scabies treatment, and recommendations in one nation may not be appropriate in others [8]. The first line treatment options are topical agents and require whole body application for many hours duration [13]. Multiple treatment doses are often recommended over days to weeks. Topical or oral antibiotic therapy may be required if secondary skin infection has developed [14]. It has also been advised that close contacts of people with scabies should be treated simultaneously, as they may be infected without yet manifesting symptoms, and so can act as a reservoir of infection [14, 15]. Treating the contacts may prevent reinfection of the index cases following treatment [13]. The logistics to treat all contacts simultaneously are significant as it requires identification and treatment of all contacts of an index case (e.g. family members, other coinhabitants, medical and other supporting staff and others who may come in contact with the index cases) [14, 16].
Table 1

Evidence of resistance to classical treatments used in scabies management

Study

Indicative cure rate

Drugs and treatment regimen

Comments

Topical

Benzyl benzoate

[45] Moberg et al., 1984

(43 %; 6/14)

benzyl benzoate (22.5 %)

case report

[46] Yonkosky et al., 1990

(12 %; 23/195)

benzyl benzoate (50 %)

case study

[47] Nnoruka et al., 2001

(48 %; 14/29)

benzyl benzoate (22.5 %)

clinical exploratory study

[38] Glaziou et al., 1993

(48 %; 10/21)

benzyl benzoate (10 %)

RCT

Permethrin

[38] Leibowitz, 1993

(0 %; 0/11)

permethrin 5 % cream

un-controlled case study

[40] Fraser, 1994

 

permethrin

(in vitro study)

[48] Walton et al., 2000

 

"

(in vitro study)

[37] Pasay et al., 2006

 

"

(in vitro study)

[39] Pasay et al., 2008

 

"

(in vitro study)

[33] Mounsey et al., 2008

 

"

(in vitro study)

[34] Mounsey et al., 2009

 

"

(in vitro study)

[49] Saqib et al., 2012

  

quasi clinical study, re-infestation after successful treatment (7 %; 4/60)

[50] Huffam et al., 1997

(0 %; 0/20)

permethrin 5 % cream

crusted scabies   

Sulphur

[51] Coskey RJ, 1979

(0 %; 0/1)

sulphur 5 % in an ointment

case report

Oral

Ivermectin

[52] Glaziou et al., 1993

(70 %; 16/23)

single dose, 100 μg/kg

RCT, poor efficacy partly attributed to the lower dose used in the study

[30] Currie et al., 1994

(0 %; 0/1)

two doses, 200 μg/kg

case report, crusted scabies

[33] Currie B.J 1999

 

five dose regimen, 200 μg/kg

crusted scabies, monthly administration failed to prevent reinfestation

[36] Currie et al., 2004

(0 %; 0/2)

seven doses, 270 μg/kg

reinfestation following seven doses, unpublished observations

[53] Brooks, et al., 2002

(56 %; 24/43)

single dose, 200 μg/kg

results evaluated at 3 weeks post treatment

[33] Mounsey et al., 2008

  

In vitro study

[41] van den Hoek et al., 2008

(0 %; 0/7)

 

case report

[34] Mounsey et al., 2009

  

In vitro study

[42] Ly et al., 2009

 

(30 %;16/53) single dose, 150–200 μg/kg

first RCT to report resistance of ivermectin

[43] Rizvi et al., 2011

 

(78 %; 38/50) single dose, 200 μg/kg

quasi clinical study

[54] Fujimoto et al., 2014

(0 %; 0/1)

6000 μg/week* 3 + 12000 μg/week *3

case report

[49] Saqib et al., 2012

  

quasi clinical study, re-infestation after successful treatment (7 %; 4/60)

[50] Huffam et al., 1997

(60 %; 12/20)

one-three doses, 200 μg/kg combined with topical scabicide and keratolytic therapy

crusted scabies

Table 2

An overview of classical treatments indicated for the management of scabies in Australia

Study

Drugs

Dosage

Treatment regimen

Contraindication

Disadvantages

Comments

 

Topical

[55, 56]

Benzyl benzoate

25 % solution

one or several consecutive 24-h applications

pregnant women and infants

burning or stinging, pruritus, dermatitis, convulsions (rare)

In use since 1930s; possible neurological complications with misuse; withdrawn in the European Union due to neurotoxicity concerns

[23, 56–58]

Permethrin

5 % cream (8–14 h) then wash off

apply overnight

infants aged <2 months

mild burning, itching stinging, pruritus, erythema, tingling, persistent excoriation, dystonia (rare), convulsions (rare)

in use since the 1980s; relatively expensive; growing resistance among scabies mites poor compliance reported in mass community intervention programs

[59, 60]

Sulphur

2–10 % precipitate in petroleum base

apply for 24 h, and then wash and reapply repeat applications for 3 days

 

noxious, malodorous messy; not given as first-line agents; multiple applications required; can cause skin irritation;

has been used for centuries; indicated in infants, pregnant and lactating women; inexpensive

 

Oral

[53, 61–63]

Ivermectin

200 μg/kg orally repeated after 1–2 weeks

 

children aged <5 years.; children <15 kg; pregnant or lactating women

transient side effects: gastrointestinal disorders; pustular rash, cellulitis; abdominal pain, diarrhoea, headache, vomiting, hypotension, toxic epidermal necrosis, mucosal drug eruption, fever, anorexia, lymph node swelling, eosinophilia, pain of joint and muscles, mazzotti reaction

in use since 1980’s (for the mass treatment of onchocerciasis, and filariasis); not approved for the treatment of typical scabies (except in Japan, Brazil, France); only indicated if symptoms persists 3 weeks after application of benzyl benzoate or permethrin; no ovicidal activity, thus repeat treatment is required; one report of increased deaths among elderly patients during scabies outbreak in an institutional setting (1997); there has been considerable criticism on the validity of this report, no other studies have replicated these findings

Most treatments (Table 2) are potentially hazardous and are associated with moderate to severe side effects (e.g. secondary eczematisation, oedema, erosions and/or pyoderma) [17–22]. The most frequent complication of topical scabicides is persisting post-scabies eczema (generalised eczematous dermatitis) resulting from irritant effects of the various formulations [23]. These may escalate xerosis and worsen delayed-type eczema. Further, it may be difficult to treat patients with secondary eczematisation, erosions or ulcers using currently available topical scabicidal agents such as permethrin, lindane, benzoyl peroxide and sulphur, as they can cause serious cutaneous and systemic side-effects in addition to the problem of compliance, resulting in poor treatment uptake [24].

Oral ivermectin is not widely available and has not been approved for the management of scabies in many countries [8]. At present, there is some observational evidence of its effectiveness in controlling scabies outbreaks in institutional settings including nursing homes [5]. However; the safety or efficacy of ivermectin, the sole oral therapy available, has not been well-established in the elderly, patients with impaired liver function (potential for toxicity resulting from long elimination half-life [36 h]), children (aged <5 years) and pregnant women, where the blood–brain barrier is incompletely developed in the foetus, raising the potential for neurotoxicity [12]. Because of the drug’s lipophilicity, ivermectin may be poorly distributed in the asteototic stratum corneum of the elderly compared to younger patients, leading to mediocre therapeutic responses in the former patient cohort and requiring combination therapy with topical scabicides [12]. Ivermectin is not ovicidal, does not adequately penetrate the thick egg shell of the scabies mite, and is also ineffective against the younger stages of the parasite (whose nervous system is poorly developed), resulting in delayed therapeutic response [25].

Mass drug administration (MDA) programs have been attempted to use ivermectin to control scabies in endemic communities around the world [26]. However, such programs’ superiority over alternative topical treatment is questionable [27, 28]. Ivermectin is indicated in Australia only for crusted scabies or cases of typical scabies when prior topical treatment has failed or has been contraindicated [29]. It is generally recommended that for maximum absorption ivermectin must be given in empty stomach [30], which is a challenge in community-based programs. Ivermectin administration can be labour-intensive since the weight of all patients and the pregnancy status of all women of childbearing age must be determined. Paradoxically, its use is not recommended in those under 5 years of age when these are the most vulnerable group (particularly among Aboriginal and Torres Strait Islander children) [29, 30]. Institutional outbreaks of scabies in aged care centres, prisons, hospital wards and kindergartens are not uncommon developed counties. In Australia it is neither given to contacts of index cases, nor to households in heavily infected large communities, as the prescribing information does not support ivermectin administration to contacts of index cases [31].

Permethrin resistance is widespread in other ectoparasites [32]. Evidence of increasing acaricide resistance leading to treatment failures has been reported (Table 1) [33–37]. In vitro sensitivity data of scabies mites from the last 10 years (Australian data) indicate that median survival times to leading acaricides (ivermectin and permethrin) have increased 2–3 fold [33, 34]. Treatment failure of permethrin as a scabicide in Indigenous communities in Australia (following MDA) and elsewhere has been documented and it is the slowest-acting acaricide (in vitro) in the Northern Territory, Australia [33, 38]. Permethrin resistance to scabies mites has been confirmed in an animal model and its likely resistance mechanism has also been documented [37, 39]. Since the first documented case in Australia in 1994 [40], there have been reports of resistance of Sarcoptes scabiei to ivermectin in vitro and in vivo, including treatment failure in clinical trials [30, 34, 41–43]. MDAs programs that encounter poor compliance increase the risk of developing resistance and targeted treatment of index cases and contacts may be a better approach [44].

Conclusions

  • Availability of a ‘fool-proof’ diagnostic tool will enable the selective treatment of affected individuals, decrease the potential for escalating mite resistance, and reduce the need for mass treatment and the associated costs.

  • Long-term adherence difficulties, safety and efficacy uncertainties in the young and elderly, and growing concerns over the development of resistance to classical scabicides, all signal the need to identify new treatment options for scabies (with greater levels of treatment compliance in MDA programs) to reduce the burden of infection in endemic settings and the morbidity and mortality associated with it.

Abbreviations

MDA: 

Mass Drug Administration Programs

WHO: 

World Health Organisation

Declarations

Acknowledgements

We would like to thank Mr Nirmal Mathew for accessing the reference material from author’s host institution/s.

Authors’ Affiliations

(1)
Faculty of Health, University of Canberra, Bruce, 2601, ACT, Australia
(2)
Faculty of Health, University of Tasmania, Hobart, 7005, TAS, Australia
(3)
Faculty of Science; Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, 4558, QLD, Australia
(4)
School of Medicine and Pharmacology (M503), The University of Western Australia, Nedlands, 6009, WA, Australia
(5)
Translational Renal Research Group, Harry Perkins Institute of Medical Research, Nedlands, 6009, WA, Australia
(6)
Charnwood, Canberra, 2615, ACT, Australia

References

  1. Orion E, Marcos B, Davidovici B, Wolf R. Itch and scratch: scabies and pediculosis. Clin Dermatol. 2006;24(3):168–75.View ArticlePubMedGoogle Scholar
  2. The Lancet Global Health Blog: “Scabies added to the World Health Organisation list of Neglected Tropical Diseases”. (2014), Available at: http://globalhealth.thelancet.com/2014/07/07/scabies-joins-list-whoneglected-tropical-diseases (Last accessed 19 June 2015).
  3. Connors C. Scabies treatment. Northern Territory Disease Control Bulletin. 1994;2:5–6.Google Scholar
  4. Clucas DB, Carville KS, Connors C, Currie BJ, Carapetis JR, Andrews RM. Disease burden and health-care clinic attendances for young children in remote Aboriginal communities of northern Australia. Bull World Health Organ. 2008;86(4):275–81.View ArticlePubMedPubMed CentralGoogle Scholar
  5. McLean FE. The elimination of scabies: a task for our generation. Int J Dermatol. 2013;52(10):1215–23.PubMedGoogle Scholar
  6. Andrews RM, Kearns T, Connors C, et al. A regional initiative to reduce skin infections amongst aboriginal children living in remote communities of the Northern Territory, Australia. PLoS Negl Trop Dis. 2009;3(11):e554.View ArticlePubMedPubMed CentralGoogle Scholar
  7. Kline K, McCarthy JS, Pearson M, Loukas A, Hotez PJ. Neglected tropical diseases of Oceania: review of their prevalence, distribution, and opportunities for control. PLoS Negl Trop Dis. 2013;7(1):e1755.View ArticlePubMedPubMed CentralGoogle Scholar
  8. Bouvresse S, Chosidow O. Scabies in healthcare settings. Curr Opin Infect Dis. 2010;23(2):111–8.View ArticlePubMedGoogle Scholar
  9. Walton SF, Holt DC, Currie BJ, Kemp DJ. Scabies: new future for a neglected disease. Adv Parasitol. 2004;57:309–76.View ArticlePubMedGoogle Scholar
  10. Jayaraj R, Hales B, Viberg L, Pizzuto S, Holt D, Rolland JM, et al. A diagnostic test for scabies: IgE specificity for a recombinant allergen of Sarcoptes scabiei. Diagn Microbiol Infect Dis. 2011;71(4):403–7.Google Scholar
  11. Strong M, Johnstone P. Interventions for treating scabies (Review). Cochrane Database Syst Rev. 2007;3:CD000320.PubMedGoogle Scholar
  12. Haas N, Lindemann U, Frank K, Sterry W, Lademann J, Katzung W. Rapid and preferential sebum secretion of ivermectin: a new factor that may determine drug responsiveness in patients with scabies. Arch Dermatol. 2002;138(1):1618–9.View ArticlePubMedGoogle Scholar
  13. FitzGerald D, Grainger RJ, Reid A. Interventions for preventing the spread of infestation in close contacts of people with scabies. Cochrane Database Syst Rev. 2014;2:CD009943.PubMedGoogle Scholar
  14. Scheinfeld N. Controlling scabies in institutional settings. Am J Clin Dermatol. 2004;5(1):31–7.View ArticlePubMedGoogle Scholar
  15. Paasch U, Haustein UF. Management of endemic outbreaks of scabies with allethrin, permethrin, and ivermectin. Int J Dermatol. 2000;39(6):463–70.View ArticlePubMedGoogle Scholar
  16. Stoevesandt J, Carlé L, Leverkus M, Hamm H. Control of large institutional scabies outbreaks. J Dtsch Dermatol Ges. 2012;10(9):637–47.PubMedGoogle Scholar
  17. Burkhart CG, Burkhart CN, Burkhart KM. An epidemiologic and therapeutic reassessment of scabies. Cutis. 2000;65:233–40.PubMedGoogle Scholar
  18. Chosidow O. Clinical practices. Scabies. N Engl J Med. 2006;354(16):1718–27.View ArticlePubMedGoogle Scholar
  19. Currie BJ, McCarthy JS. Permethrin and ivermectin for scabies. N Engl J Med. 2010;362(8):717–25.View ArticlePubMedGoogle Scholar
  20. Hay RJ, Steer AC, Engelman D, Walton S. Scabies in the developing world-its prevalence, complications, and management. Clin Microbiol Infect. 2012;18(4):313–23.View ArticlePubMedGoogle Scholar
  21. Kemp DJ, Walton SF, Harumal P, Currie BJ. The Scourge of Scabies. Biologist. 2002;49(1):19–24.PubMedGoogle Scholar
  22. Hicks MI, Elston DM. Scabies. Dermatol Ther. 2009;22(4):279–92.View ArticlePubMedGoogle Scholar
  23. Hengge UR, Currie BJ, Jager G, Lupi O, Schwartz RA. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis. 2006;6(12):769–79.View ArticlePubMedGoogle Scholar
  24. Goldust M, Rezaee E, Hemayat S. Treatment of scabies: comparison of permethrin 5 % versus ivermectin. J Dermatol. 2012;39(6):545–7.View ArticlePubMedGoogle Scholar
  25. Usha V, Gopalakrishnan NT. A comparative study of oral ivermectin and topical permethrin cream in the treatment of scabies. J Am Acad Dermatol. 2000;42(2):236–40.View ArticlePubMedGoogle Scholar
  26. Engelman D, Martin DL, Hay RJ, et al. Opportunities to investigate the effects of ivermectin mass drug administration on scabies. Parasit Vectors. 2013;6:106.View ArticlePubMedPubMed CentralGoogle Scholar
  27. Haar K, Romani L, Filimone R, et al. Scabies community prevalence and mass drug administration in two Fijian villages. Int J Dermatol. 2014;53(6):739–45.View ArticlePubMedGoogle Scholar
  28. Kearns T, Andrews R, Speare R, et al. Prevalence of scabies and strongyloidiasis before and after MDA in a remote Aboriginal community in Northern Territory, Australia. Int J Infect Dis. 2014;21(1):252.View ArticleGoogle Scholar
  29. Therapeutic Goods Administration (TGA): “Australian Public Assessment Report for Ivermectin (Stromectol®)”. 2013, Available at: http://www.tga.gov.au/auspar/auspar-ivermectin (Last accessed 19 June 2015).
  30. Australian Prescriber: “New drugs- Ivermectin”. 1997, Available at http://www.australianprescriber.com/magazine/20/3/77/9/new-drugs/149/ivermectin (Last accessed 19 June 2015).
  31. NPS MedicineWise: “Ivermectin (Stromectol) for scabies. NPS Medicine Update”. 2014. Available at: http://www.nps.org.au/publications/consumer/medicine-update/2014/ivermectin-stromectol-for-scabies (Last accessed 24 March 2015).
  32. Heukelbach J, Feldmeier H. Ectoparasites-the underestimated realm. Lancet. 2004;363(9412):889–91.View ArticlePubMedGoogle Scholar
  33. Mounsey KE, Holt DC, McCarthy J, Currie BJ, Walton SF. Scabies: molecular perspectives and therapeutic implications in the face of emerging drug resistance. Future Microbiol. 2008;3(1):57–66.View ArticlePubMedGoogle Scholar
  34. Mounsey KE, Holt DC, McCarthy JS, Currie BJ, Walton SF. Longitudinal evidence of increasing in vitro tolerance of scabies mites to ivermectin in scabies-endemic communities. Arch Dermatol. 2009;145(7):840–1.View ArticlePubMedGoogle Scholar
  35. Terada Y, Murayama N, Ikemura H, Morita T, Nagata M. Sarcoptes scabiei var. canis refractory to ivermectin treatment in two dogs. Vet Dermatol. 2010;21(6):608–12.View ArticlePubMedGoogle Scholar
  36. Currie BJ, Harumal P, McKinnon M, Walton SF. First documentation of in vivo and in vitro ivermectin resistance in Sarcoptes scabiei. Clin Infect Dis. 2004;39(1):e8–12.View ArticlePubMedGoogle Scholar
  37. Pasay C, Walton S, Fischer K, Holt D, McCarthy J. PCR-based assay to survey for knockdown resistance to pyrethroid acaricides in human scabies mites (Sarcoptes scabiei var hominis). AmJTrop Med Hyg. 2006;74(4):649–57.Google Scholar
  38. Leibowitz MR. Failure of scabies treatment. N Z Med J. 1993;106(960):317–8.PubMedGoogle Scholar
  39. Pasay C, Arlian L, Morgan M, et al. High-resolution melt analysis for the detection of a mutation associated with permethrin resistance in a population of scabies mites. Med Vet Entomol. 2008;22(1):82–8.View ArticlePubMedGoogle Scholar
  40. Fraser J. Permethrin: a Top End viewpoint and experience. Med J Aust. 1994;160(12):806.PubMedGoogle Scholar
  41. van den Hoek JA, van de Weerd JA, Baayen TD, et al. A persistent problem with scabies in and outside a nursing home in Amsterdam: indications for resistance to lindane and ivermectin. Euro Surveillance. 2008;13(48):19052.PubMedGoogle Scholar
  42. Ly F, Caumes E, Ndaw CA, Ndiaye B, Mahe A. Ivermectin versus benzyl benzoate applied once or twice to treat human scabies in Dakar, Senegal: a randomized controlled trial. Bull World Health Organ. 2009;87(6):424–30.View ArticlePubMedPubMed CentralGoogle Scholar
  43. Rizvi SDA, Iftikhar N, Batool F. Effectiveness of oral ivermectin for eradicating infesting mites in patients of scabies. J Pak Assoc Dermatol. 2011;21(2):87–92.Google Scholar
  44. Gilmore SJ. Control strategies for endemic childhood scabies. PLoS ONE. 2011;6(1):e15990.View ArticlePubMedPubMed CentralGoogle Scholar
  45. Moberg SA, Lowhagen GB, Hersle KS. An epidemic of scabies with unusual features and treatment resistance in a nursing home. J Am Acad Dermatol. 1984;11(2 Pt 1):242–4.View ArticlePubMedGoogle Scholar
  46. Yonkosky D, Ladia L, Gackenheimer L, Schultz MW. Scabies in nursing homes: an eradication program with permethrin 5 % cream. J Am Acad Dermatol. 1990;23(6 Pt 1):1133–6.View ArticlePubMedGoogle Scholar
  47. Nnoruka EN, Agu CE. Successful treatment of scabies with oral ivermectin in Nigeria. Trop Dr. 2001;31(1):15–8.Google Scholar
  48. Walton SF, Myerscough MR, Currie BJ. Studies in vitro on the relative efficacy of current acaricides for Sarcoptes scabiei var. hominis. Trans R Soc Trop Med Hyg. 2000;94(1):92–6.View ArticlePubMedGoogle Scholar
  49. Saqib M, Afridi IU, Ali A, Jahangir M. Scabies; Safety of Permethrin and ivermectin. Professional Med J. 2012;19(1):86.Google Scholar
  50. Huffam SE, Currie BJ. Ivermectin for Sarcoptes scabiei hyperinfestation. Int J Infect Dis. 1998;2(3):152–4.View ArticlePubMedGoogle Scholar
  51. Coskey RJ. Scabies-resistance to treatment with crotamiton. Arch Dermatol. 1979;115(1):109.View ArticlePubMedGoogle Scholar
  52. Glaziou P, Cartel J, Alzieu P, Briot C, Moulia-Pelat J, Martin P. Comparison of ivermectin and benzyl benzoate for treatment of scabies. Trop Med Parasitol. 1993;44(4):331–2.PubMedGoogle Scholar
  53. Brooks P, Grace R. Ivermectin is better than benzyl benzoate for childhood scabies in developing countries. J Paediatr Child Health. 2002;38(4):401–4.View ArticlePubMedGoogle Scholar
  54. Fujimoto K, Kawasaki Y, Morimoto K, Kikuchi I, Kawana S. Treatment for crusted scabies: limitations and side effects of treatment with ivermectin. J Nippon Med Sch. 2014;81(3):157–63.View ArticlePubMedGoogle Scholar
  55. Roos TC, Roos S, Merk HF, Bickers DR. Pharmacotherapy of ectoparasitic infections. Drugs. 2001;61(8):1067–88.View ArticlePubMedGoogle Scholar
  56. Walker G, Johnstone P. Interventions for treating scabies (Cochrane Review). Cochrane Database Syst Rev. 2000;3:CD000320.PubMedGoogle Scholar
  57. Coleman CI, Gillespie EL, White CM. Probable topical permethrin‐induced neck dystonia. Pharmacotherapy. 2005;25(3):448–50.View ArticlePubMedGoogle Scholar
  58. Schultz MW, Gomez M, Hansen RC, Mills J, Menter A, Rodgers H, et al. Comparative study of 5 % permethrin cream and 1 % lindane lotion for the treatment of scabies. Arch Dermatol. 1990;126(2):167–70.Google Scholar
  59. Singalavanija S, Limpongsanurak W, Soponsakunkul S. A comparative study between 10 % sulfur ointment and 0.3 % gamma benzene hexachloride gel in the treatment of scabies in children. J Med Assoc Thail. 2003;86:S531–6.Google Scholar
  60. Karthikeyan K. Treatment of scabies: newer perspectives. Postgrad Med J. 2005;81(951):7–11.View ArticlePubMedPubMed CentralGoogle Scholar
  61. Chouela EN, Abeldano AM, Pellerano G, La Forgia M, Papale RM, Garsd A, et al. Equivalent therapeutic efficacy and safety of ivermectin and lindane in the treatment of human scabies. Arch Dermatol. 1999;135(6):651–5.Google Scholar
  62. del Giudice P. Ivermectin in scabies. Curr Opin Infect Dis. 2002;15(2):123–6.View ArticlePubMedGoogle Scholar
  63. Barkwell R, Shields S. Deaths associated with ivermectin treatment of scabies. Lancet. 1997;349(9059):1144–5.View ArticlePubMedGoogle Scholar

Copyright

© Thomas et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement

BMC Infectious Diseases

ISSN: 1471-2334

Contact us