How effective is permethrin topical for treating scabies. What are the common side effects of using permethrin cream. How should permethrin be applied to treat scabies effectively. What precautions should be taken when using permethrin for scabies.

Understanding Scabies: Causes, Symptoms, and Diagnosis

Scabies is a highly contagious skin infestation caused by tiny mites that burrow into the upper layers of the skin. These microscopic parasites, known as Sarcoptes scabiei, lay eggs and leave feces under the skin, leading to intense itching and a distinctive rash.

The primary symptoms of scabies include:

• Intense itching, especially at night
• A pimple-like rash, often in a line or track
• Thin, irregular burrow tracks made up of tiny blisters or bumps on the skin

Scabies commonly affects areas such as the hands, wrists, elbows, armpits, waist, buttocks, and genitals. In children, it may also appear on the head, neck, palms, and soles of the feet.

Diagnosing scabies typically involves a physical examination and microscopic identification of mites, eggs, or feces from skin scrapings. In some cases, a dermoscopy may be used to visualize the burrows and mites.

How is scabies transmitted?

Scabies is primarily spread through prolonged skin-to-skin contact with an infected person. This commonly occurs among household members, sexual partners, and in crowded living conditions. The mites can also spread through sharing clothing, bedding, or towels with an infected individual, although this is less common.

Permethrin Topical: An Effective Treatment for Scabies

Permethrin topical is a widely prescribed medication for the treatment of scabies. It belongs to a class of drugs called pyrethrins, which work by paralyzing and killing the scabies mites and their eggs. Permethrin is available as a 5% cream or lotion and is considered a first-line treatment for scabies due to its efficacy and safety profile.

How does permethrin work against scabies?

Permethrin functions by disrupting the nervous system of the scabies mites. When applied to the skin, it penetrates the burrows where the mites reside and effectively kills both the adult mites and their eggs. This action helps to break the life cycle of the parasites and eliminate the infestation.

Proper Application of Permethrin for Scabies Treatment

To ensure the maximum effectiveness of permethrin topical in treating scabies, it’s crucial to follow the correct application procedure:

1. Thoroughly wash and dry the entire body.
2. Apply the permethrin cream or lotion to the entire body from the neck down, including under the nails.
3. Leave the medication on for 8-14 hours, typically overnight.
4. Rinse off the medication with lukewarm water.
5. Put on clean clothes and change bedding after treatment.

It’s important to note that a single application may not be sufficient to completely eradicate the infestation. A second treatment is often recommended 7-14 days after the initial application to ensure all mites and eggs are eliminated.

Can permethrin be used on children and infants?

Permethrin is generally considered safe for use in children and infants over 2 months of age. However, it’s essential to consult with a healthcare provider before using the medication on young children or infants. In some cases, the application procedure may need to be modified for infants, such as applying the cream to the scalp and face while avoiding the mouth and eye areas.

Efficacy of Permethrin Topical: Clinical Evidence and User Reviews

Clinical studies have consistently shown permethrin to be highly effective in treating scabies. A systematic review of scabies treatments found that permethrin was more effective than other topical treatments, including crotamiton and lindane.

User reviews of permethrin topical for scabies treatment reveal mixed experiences. According to the data provided, permethrin topical has an average rating of 5.6 out of 10 from a total of 15 reviews for the treatment of scabies. 47% of reviewers reported a positive experience, while 33% reported a negative experience.

Why do some users report negative experiences with permethrin?

Several factors may contribute to negative experiences with permethrin:

• Incorrect application technique
• Failure to treat all close contacts simultaneously
• Reinfestation from untreated sources
• Misdiagnosis of the condition
• Individual variations in response to the medication

It’s important to note that while permethrin is generally effective, it may not work for everyone, and alternative treatments may be necessary in some cases.

Side Effects and Precautions When Using Permethrin

While permethrin is considered safe for most individuals, it can cause some side effects. Common side effects may include:

• Mild burning or stinging sensation
• Itching
• Redness or swelling of the skin
• Numbness or tingling

In rare cases, more severe side effects such as severe burning, blistering, or allergic reactions may occur. It’s important to seek medical attention if any severe or persistent side effects are experienced.

Are there any contraindications for using permethrin?

Permethrin should not be used by individuals with a known allergy to pyrethrins or chrysanthemums. Pregnant women should consult their healthcare provider before using permethrin, although it is generally considered safe during pregnancy when used as directed.

Alternative Treatments for Scabies

While permethrin is often the first-line treatment for scabies, there are alternative options available, especially for those who may not respond to permethrin or have contraindications:

• Ivermectin: An oral medication that can be effective against scabies
• Crotamiton: A topical medication that can be used as an alternative to permethrin
• Sulfur ointment: An older treatment that may be used in certain cases, particularly for infants
• Benzyl benzoate: A topical medication used in some countries

These alternatives may be prescribed based on individual patient factors, local availability, and treatment guidelines.

How does oral ivermectin compare to topical permethrin in treating scabies?

Oral ivermectin has shown comparable efficacy to topical permethrin in treating scabies. Some studies suggest that ivermectin may be more convenient for patients and potentially more effective in cases of severe or crusted scabies. However, the choice between ivermectin and permethrin often depends on factors such as local treatment guidelines, patient preference, and individual clinical situations.

Preventing Scabies Reinfestation and Transmission

Successful treatment of scabies involves not only eliminating the mites from the infected individual but also preventing reinfestation and transmission to others. Key prevention strategies include:

1. Treating all household members and close contacts simultaneously, even if they don’t show symptoms
2. Washing all clothing, bedding, and towels used by the infected person in hot water (at least 60°C) and drying on high heat
3. Sealing items that can’t be washed in plastic bags for at least 72 hours
4. Vacuuming carpets and upholstered furniture thoroughly
5. Avoiding close physical contact with infected individuals until treatment is complete

It’s important to note that scabies mites cannot survive for more than 2-3 days away from human skin, so extensive cleaning of the environment is usually not necessary.

How long does it take for scabies symptoms to resolve after treatment?

After successful treatment with permethrin or other scabicides, itching may persist for several weeks. This is due to the body’s allergic reaction to the dead mites and their waste products. It’s important to resist the urge to re-treat prematurely, as overuse of scabicides can lead to skin irritation and potentially contribute to the development of resistance.

The Impact of Scabies on Quality of Life and Mental Health

Scabies can have a significant impact on an individual’s quality of life and mental health. The intense itching, especially at night, can lead to sleep disturbances, fatigue, and decreased concentration. The visible nature of the rash and the stigma associated with parasitic infestations can cause emotional distress, anxiety, and social isolation.

Moreover, the contagious nature of scabies can strain relationships and lead to fear of transmitting the infestation to others. This can be particularly challenging in settings such as schools, nursing homes, or crowded living conditions where outbreaks can occur.

How can healthcare providers address the psychological impact of scabies?

Healthcare providers can play a crucial role in addressing the psychological impact of scabies by:

• Providing clear information about the condition and its treatment
• Offering reassurance about the curability of scabies
• Addressing concerns about transmission and stigma
• Recommending support groups or counseling if needed
• Ensuring follow-up care to monitor treatment progress and address ongoing concerns

By addressing both the physical and psychological aspects of scabies, healthcare providers can help patients manage the condition more effectively and minimize its impact on their overall well-being.

Permethrin topical for Scabies Reviews

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Permethrin topical
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47% of reviewers reported a positive experience, while 33% reported a negative experience.

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Scabies

Scabies

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• Scabies

N. Lufanga

Baby suffering from Scabies in the United Republic of Tanzania.

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Basic facts

• Human scabies is a parasitic infestation caused by Sarcoptes scabiei varhominis
• An estimated 200 million people in the world are infected with scabies at any given time
• Up to 10% of children in under-resourced areas have scabies
• Scabies is distributed throughout the world, mainly in hot tropical countries and in areas with high population density

Human scabies is a parasitic infestation caused by Sarcoptes scabiei var hominis. The microscopic mite enters the skin and lays eggs, eventually triggering an immune response in the host that results in severe itching and a rash. Scabies can be exacerbated by bacterial infections leading to the development of skin ulcers, which in turn can lead to more severe complications such as sepsis, heart disease, and chronic kidney disease. In 2017, scabies and diseases caused by other ectoparasites were listed as neglected tropical diseases (NTDs) in response to requests from Member States and recommendations from the WHO Strategic and Technical Advisory Group on NTDs.

Magnitude of the problem

Scabies is one of the most common skin diseases and accounts for a significant proportion of skin diseases in developing countries. It is estimated that over 200 million people in the world are infected with scabies at any given time, but more work is needed to better estimate this burden. According to recent publications on scabies, prevalence rates range from 0.2% to 71%.

Scabies is endemic in many resource-poor tropical areas, where average prevalence rates in children are estimated to be 5-10%. Re-infections are widespread. The heavy burden of scabies and its complications comes at a high cost to health systems. Although isolated cases occur in high-income countries, outbreaks of scabies in health care settings and vulnerable communities result in significant economic costs to national health services.

Scabies is prevalent throughout the world, but the most vulnerable populations – young children and the elderly in under-resourced communities – are particularly susceptible to scabies infection and secondary complications. Infection rates are highest in countries with hot tropical climates, especially in communities where people live in conditions of overcrowding and poverty and access to treatment is limited.

Symptoms

Scabies mites penetrate the top layer of the skin where adult females lay their eggs. After 3-4 days, larvae appear from the eggs, which develop into adult ticks in 1-2 weeks. After 4-6 weeks, the patient develops an allergic reaction to the proteins and feces of the mites in the scabies, which causes severe itching and a rash. Most people are infected with 10-15 mites.

Patients usually experience severe itching, and tick-like burrows and vesicles appear in the interdigital spaces, on the wrists, on the upper and lower extremities and in the lumbar region. In infants and young children, the rash may be more widespread and involve the palms, soles of the feet, ankles, and sometimes the scalp. Inflammatory scabies nodules can be found in adult men on the penis and scrotum, and in women in the mammary glands. Due to the fact that symptoms develop some time after the initial infection, itch moves can be detected in people who have had close contact with an infected person who have not yet developed itching.

People with crusted scabies develop thick, scaly scabies on their skin that may spread more widely, including on the face.

Immunocompromised people, including people with HIV/AIDS, can develop a special form of the disease called crusted (Norwegian) scabies. Crusted scabies is a hyperinfection, in which the number of mites reaches several thousand and even millions. The mites spread widely and lead to crusting, but often do not cause significant itching. If left untreated, this disease is characterized by high mortality from secondary sepsis.

The effects of mites on the immune system, as well as the direct effects of scratching, can lead to bacterial contamination of the skin, leading to the development of impetigo (skin ulcers), especially in tropical conditions. Impetigo may be complicated by deeper skin infections such as abscesses or severe invasive diseases, including sepsis. In tropical settings, skin infection associated with scabies is a common risk factor for kidney disease and possibly rheumatic heart disease. Signs of acute kidney injury can be found in up to 10% of scabies-infected children in under-resourced areas, and in many cases these symptoms persist for years after infection, leading to irreversible kidney damage.

Transmission

Scabies is usually spread from person to person through close skin contact (eg, living together) with an infected person. The risk of transmission depends on the level of infection, with the highest risk coming from contact with individuals suffering from crusting scabies. The likelihood of transmission from contact with contaminated personal items (eg clothing and bedding) is low for common scabies, but high for crusted scabies. Given the asymptomatic period of infection, transmission may occur before symptoms appear in the initially infected person.

Treatment

Initial treatment of infected individuals includes the use of topical scabicides such as 5% permethrin, 0.5% water-based malathion, 10-25% benzyl benzoate emulsion, or 5-10% sulfur ointment. Oral ivermectin is also highly effective and has been approved in several countries. The safety of ivermectin in pregnant women or children weighing less than 15 kg has not been established, so ivermectin should not be used in these populations until further safety data are available. With effective treatment within 1-2 weeks, pruritus usually increases, and persons undergoing treatment should be informed about this.

Since there may be no symptoms in the early stages of a new infestation, and since anti-scabies drugs do not kill the eggs of the parasite, best results are achieved by treating all family members at the same time and re-treatment at a time appropriate to the chosen drug.

WHO activities

WHO is collaborating with Member States and partners to develop scabies control strategies and outbreak response plans. WHO recognizes that the burden of disease and the risk of long-term complications need to be better defined, and that scabies control strategies need to be linked to interventions to facilitate rapid and cost-effective implementation. WHO is working to have ivermectin included on the WHO Model List of Essential Medicines when it is next updated. In addition, WHO is taking steps to ensure that quality and effective medicines are available to countries in need.

what it looks like, symptoms, signs and treatment

Scabies: a definition of the disease

Scabies (or, scientifically, scabies) is a common contagious skin disease.

In the last decade in Russia, the incidence of scabies is officially kept at the level of 18-45 cases per 100 thousand people. But it can be much higher, since people do not go to the doctor: they try to cope with the disease on their own or are ashamed of their symptoms.

Scabies agent

The cause of the disease is the scabies mite Sarcoptes scabiei, which feeds on flakes of dead skin. It spends most of its life in the skin, and appears on the surface only for mating.

The size of an adult tick is approximately 0.1 mm. The parasite has a powerful jaw, with the help of which it gnaws tunnels in the skin

As a rule, mating of ticks occurs in the evening. After it, the males die, and the females gnaw through human skin and make scabies in it, in which they lay 2-4 eggs. The hatched larvae come to the surface of the skin and penetrate into the hair follicles and flakes of the epidermis (upper layer of the skin). After a couple of days, they molt and become nymphs, and then they become adults, ready to mate.

Characteristics of the scabies mite Sarcoptes scabiei:

• the tick quickly dies in the external environment: it is unable to absorb water from the air, therefore it dies from moisture deficiency;
• for the parasite, temperatures above 55 degrees are detrimental;
• adult females can penetrate the skin only in the most sensitive areas, and larvae – in any, due to their small size;
• is usually infected by females and larvae at the same time.

Ways of transmission of scabies

There are two ways of transmission of scabies – direct and indirect.

Direct infection with scabies occurs during close bodily contact. There are known cases of tick transmission from an infected person to a healthy person even during a strong handshake.

Indirect infection with scabies occurs without direct contact with an infected person. This can happen in a bathhouse, a hotel, an entrance and in other places where many people touch the same objects on which ticks are located.

Usually scabies is infected in orphanages, boarding schools, hostels, barracks, prisons – wherever people live in a large group.

The risk of contracting scabies is higher in places where people work and live in small groups

Incubation period for scabies

The incubation period for scabies depends on whether infection has occurred with adult scabies mite or its larvae.

When infested with larvae, the first symptoms may appear after 10-14 days – this is how long it takes for the mites to mature. And when infected with already fertilized females, there may not be an incubation period at all: the females will immediately begin to dig scabies and lay eggs in them in order to breed as soon as possible.

Types of scabies

Typical scabies – the most common, accompanied by excruciating itching, scabies, nodules and blisters on the skin. The characteristic symptom of the disease – itching – usually appears 10-14 days after infection. Itching intensifies in the evening and at night, it is at this time that scabies mites are active.

For the treatment of typical scabies, scabicides are prescribed – drugs that destroy mites and their larvae. The illness usually resolves within 2-3 weeks.

Clean scabies mostly occurs in people who shower or bathe in the evening. They have almost no nodules and blisters on their skin, strong scratching and bloody crusts.

Treatment for clean scabies is the same as for typical scabies. With the right choice of drugs and compliance with all the doctor’s recommendations, recovery occurs in 2-3 weeks.

Norwegian (crustal) scabies is a rare and highly contagious form of the disease. It was first identified by Norwegian doctors in 1848 in patients with leprosy (leprosy).

As a rule, Norwegian scabies occurs in immunocompromised people, in patients with Down’s syndrome, HIV, dementia, oncological diseases, as well as in patients taking hormonal and cytotoxic drugs for a long time.

With Norwegian scabies, vesicles, nodules, cracks form on the skin, and then – rough crusts – gray-yellow or brown-black. Such crusts can, like a shell, cover large areas of the skin and prevent a person from moving normally. In the lower layers of the crusts, sinuous depressions are visible – scabies. When removing the crusts, extensive weeping erosions are exposed. Between the layers of crusts, a huge number of mites are found – up to 200 individuals in one square centimeter (for comparison: with typical scabies, there are usually no more than 10-15 of them).

Norwegian scabies can cause a micro-epidemic – when all family members, health workers and patients who are in the same room become infected with the disease.

Treatment of Norwegian scabies is long and takes place in two stages. First, the doctor removes the crusts from the patient’s skin (sometimes local anesthesia is required), then prescribes anti-scabies, which will need to be used for a long time.

Scabies without burrows is less common than typical and is usually found in people who have been in contact with people with scabies. With such scabies, infection with scabies mite larvae occurs. Symptoms of the disease: single nodules and inflammatory vesicles on the skin.

Scabies without burrows usually resolves in 2 weeks, is treated in the same way as typical scabies – anti-scabies drugs.

Scabious lymphoplasia – manifested by intensely itchy flat rounded bluish-purple nodules, which are most often localized on the trunk (buttocks, abdomen, in the axillary region), as well as on the elbows and genitals in men, mammary glands in women. The basis of the disease is the reaction of the body to the waste products of the tick. This happens in people who suffer from scabies for a long time.

After complete therapy, the rash may resolve in 2 weeks to 6 months.

Scabious erythroderma occurs in people who have been treated for a long time (up to 3 months) with typical scabies with corticosteroid ointments, antipruritic and sedative drugs. The disease is manifested by many itch moves that occur even in atypical places (between the shoulder blades, on the head, on the face). At the same time, itching is mild, and patients do not comb the skin, but rub it with their palms.

Treatment of scabious erythroderma is quite long – up to 6 weeks may be required until complete recovery.

Pseudosarcoptic mange is a type of scabies that affects dogs, pigs, horses, rabbits, wolves, foxes and other animals. Pseudosarcoptic mange can only be contracted from animals. It is not transmitted from person to person.

The incubation period is several hours. There are no scabies, since the mites do not breed on an unusual host and only partially burrow into the skin, causing itching. The rashes are concentrated on open areas of the skin and look like blisters, blisters, bloody crusts and scratches.

Pseudosarcoptic mange often resolves on its own after cessation of contact with the affected animal. If the symptoms recur or persist for several days, you should consult a doctor to make an accurate diagnosis.

Symptoms of scabies

The main symptom of scabies is unbearable itching, which intensifies in the evening and at night.

Itching runs along the burrows. They look like straight or curved lines that rise above the skin. The color of the lines can be dirty gray or whitish gray. Length – 5-7 mm.

Most often, itch moves are found on the wrists, feet, male genital organs, in the interdigital spaces.

The skin of a person infected with scabies usually has blisters and nodules. In about a third of cases, young males and females of the parasite are found in them. You can see them with the naked eye: ticks look like white or yellowish dots the size of a poppy seed.

Nodules with mites are located in the area of ​​hair follicles. Bubbles are more often between the fingers, on the wrists.

The main symptom of scabies is excruciating itching

Complications of scabies

Complications of scabies in the form of dermatitis and secondary pyoderma occur in approximately 50% of patients.

Dermatitis is an inflammation of the skin, which is manifested by redness, burning, tingling, itching, swelling of the affected area. Secondary pyoderma is a purulent-inflammatory skin disease caused by bacteria.

Less often against the background of scabies develops microbial eczema – inflammation of the skin of an allergic nature caused by microbes.

Skin changes in scabies complicated by the addition of a secondary infection:

• staphylococcal impetigo – inflammation of the hair follicle caused by staphylococcus aureus;
• deep folliculitis – damage to the deep sections of the hair follicle, which leads to purulent inflammation;
• furunculosis – acute purulent-necrotic inflammation of the hair follicle, sebaceous gland and surrounding tissues;
• impetigo – vesicular-pustular rash;
• paronychia – inflammation of the periungual fold.

Scabies in children

As a rule, children become infected with scabies in a direct way – through prolonged contact with the skin of an infected person. This happens when sleeping in the same bed, contact games, using shared toys. In addition, children can catch scabies in crowded groups – in orphanages, camps, hospitals, sports clubs, swimming pools. Teenagers are infected with scabies during sexual intercourse.

The course of scabies in children is usually more pronounced than in adults. Complications develop more often – microbial eczema, pyoderma (purulent-inflammatory skin lesions), impetigo (vesicle-pustular rashes), paronychia (inflammation of the periungual roller).

Symptoms of scabies in children:

• severe itching that worsens in the evening and at night;
• rash;
• scabies;
• nodules and vesicles on the skin.

Symptoms of scabies in children are usually more pronounced than in adults

In infants and young children, rashes can be located on any area of ​​the skin – including the face, scalp, palms and soles. The rash in babies often begins to get wet, there are multiple grouped vesicles in the lesions, scabious lymphoplasia of the skin.

In school-age children and adolescents, scabies affects the hands, feet, elbows, buttocks, genitals, intergluteal folds.

Diagnosis of scabies

The diagnosis of scabies is made by a doctor – a dermatologist, therapist or infectious disease specialist – on the basis of an examination and complaints of the patient.

A clear sign of the disease is pruritus, which becomes unbearable in the evening and at night. Other symptoms that make it possible to suspect the disease are characteristic linear scratches and nodules on the skin.

Skin scrapings can confirm the diagnosis of scabies. However, it should be borne in mind that there may not be ticks in the biomaterial if the person has washed himself thoroughly before visiting the doctor.

Another way to detect a mite in a laboratory or clinic is to apply a drop of 40% lactic acid to the suspected itch, nodule, vesicle. Lactic acid loosens the epidermis well, and after a few minutes it can be carefully scraped off, placed on a glass slide and examined under a microscope.

The tick extraction method is also used. In this case, the doctor opens the blind end of the itch with a needle. The female is attached to the needle. Then the doctor takes the needle out of the itch along with the female and immerses it in a drop of water or 40% lactic acid. Then microscopy is performed.

Treatment of scabies

There are three ways to treat scabies: specific, prophylactic and trial.

Specific treatment is given to patients with symptoms of the disease and a clinically confirmed diagnosis. Scabicides are used – drugs that destroy the scabies mite and its larvae.

Prophylactic treatment is performed according to epidemiological indications – in scabies. However, people may not have symptoms.

Such treatment is indicated for everyone who has been in contact with an infected person: family members, sexual partners, nannies and nurses, members of close groups in orphanages, boarding schools, hostels, prisons, barracks.

Trial treatment is performed only in cases where the patient has symptoms of scabies, but the causative agent – scabies mite – is not detected. If after the use of anti-scabies drugs a positive effect occurs, then the diagnosis of “scabies” is considered confirmed.

Anti-scabies preparations

Ointments, emulsions, aerosols are used to kill scabies mites.

Basic scabicides – scabicides:

• preparations containing esdepalletrin, a neurotoxic insect poison. Contraindicated in pregnant women, as well as in patients with bronchial asthma and obstructive bronchitis;
• benzyl benzoate (ointment, emulsion): 20% for adults and 10% for children from 3 to 7 years;
• sulfuric ointment 33%. The drug is contraindicated in children under 3 years of age. Has an unpleasant smell, stains clothes. Possible skin irritation, longer treatment;
• permethrin 5% (emulsion). The drug is not recommended for use in children under 1 year old, patients with liver and kidney diseases, lactating women;
• crotamiton 10% (cream, lotion). Pregnant women can use the medicine only according to strict indications. In addition, the drug is contraindicated in children under 12 years of age.

The doctor prescribes the drug regimen. Self-medication can be hazardous to health.

General rules for the use of anti-scabies:

• apply drugs in the evening, with bare hands, not with a tissue or swab;
• rub preparations thoroughly into palms and soles;
• change underwear and bed linen after completion of the course;
• to simultaneously treat everyone who is in the focus of infection.

The doctor may give the patient antihistamines or topical corticosteroids to relieve itching. Both of them are usually used in a short course.

If itching does not resolve within a week, it may be necessary to re-treat the skin with scabicide preparations after thoroughly washing the patient with soap and a washcloth.

Prognosis and prevention

With proper and timely treatment, the prognosis of scabies is favorable.