Table 2 An overview of classical treatments indicated for the management of scabies in Australia

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In use since 1930s; possible neurological complications with misuse; withdrawn in the European Union due to neurotoxicity concerns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

[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