Pediatric Scabies Medication

  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 5, 2011
 

Medication Summary

Scabies is treated with topical antiparasitic medications. The treatment of choice is permethrin 5% lotion. Alternative drug therapy includes precipitated sulfur in 6% petrolatum, lindane, benzyl benzoate, crotamiton, and ivermectin; a possible new option is albendazole.[14] Topical antibiotics may be used to treat secondarily infected lesions. One study compared the efficacy of ivermectin with benzyl benzoate lotion used to treat scabies in Nigerian patients and found that ivermectin was at least as effective as benzyl benzoate and led to more rapid improvement.[15] The efficacy of benzyl benzoate lotion and permethrin were evaluated in a retrospective matched cohort study of pregnant women.[16] No adverse effects on pregnancy outcome were reported in patients using either drug.

Scabies outbreaks in nursing homes and cases of scabies crustosa may require management that includes combination therapy that consists of topical application of permethrin and 2 oral doses of ivermectin at 200 mcg/kg (administered 1 wk apart).[17] . Bullous scabies may respond to ivermectin therapy.[18]

Few effective treatments have been identified. In addition, recent observations have noted emerging drug resistance to oral ivermectin and 5% permethrin.[19] Thus, the need to define molecular mechanisms of drug resistance in scabies mites is urgent, as is the development and assessment of alternative therapeutic options (eg, tea tree oil).

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Scabicidal agents

Class Summary

Mechanisms of action in these agents include depolarization and paralysis of the mites or nervous system stimulation.

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Permethrin 5% (Elimite, Nix)

 

Neurotoxin that causes paralysis and death in ectoparasites. Most common treatment for scabies. DOC, particularly for infants, young children, and pregnant or breastfeeding women. The lotion should be applied over the entire body, including the face and scalp in infants. It should be left on for 8-12 h and then rinsed. Reapplication 1 wk later is advised; however, no controlled studies have demonstrated that 2 applications are more effective than one application.

Precipitated sulfur 6% in petrolatum

 

Oldest known treatment of scabies. It is safe and effective and is the treatment of choice in infants < 2 mo and in pregnant or lactating women. Sulfur is less acceptable to patients secondary to its odor and messy application.

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Lindane (gamma benzene hexachloride, Kwell)

 

Previous DOC for scabies, now considered second-line treatment if other agents fail or are not tolerated. Transcutaneous absorption can lead to neurotoxicity.

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Crotamiton 10% (Eurax)

 

Used for the treatment of scabies. Mechanism of action is unknown. Associated with frequent treatment failures.

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Ivermectin (Mectizan, Stromectol)

 

Synthetic derivative of the antiparasitic class of compounds called avermectins. This macrolide endectocide is active not only against scabies but also against head lice, demodicidosis, cutaneous larva migrans, cutaneous larva currens, myiasis, and filariasis. Currently approved for the treatment of human onchocerciasis and strongyloidiasis. Although not FDA-approved for the treatment of scabies, it is widely used and literature supports its use.

Selectively binds with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death. Half-life is 16 h; metabolized in liver. It kills the mites but does not affect the eggs.

Ivermectin has been recently researched as a PO treatment for scabies. A single dose PO has also been found to be highly efficacious in the treatment of scabies in patients with HIV. Still in the early stages of trial.

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Topical antibiotics

Class Summary

These agents are used to treat lesions with secondary infection.

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Mupirocin (Bactroban)

 

Used to treat Staphylococcus species, beta-hemolytic streptococci, and Streptococcus pyogenes. Inhibits protein and RNA synthesis by inactivating transfer-RNA synthetase.

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Topical corticosteroids

Class Summary

These agents may be applied to help control intense pruritus caused by scabies.

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Hydrocortisone, topical (Cortaid, Dermacort, Westcort, CortaGel)

 

An adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Has mineralocorticoid and glucocorticoid effects that result in anti-inflammatory activity. Considered to be the lowest-potency topical steroid.

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Contributor Information and Disclosures
Author

Camila K Janniger, MD  Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Giuseppe Micali, MD  Head, Professor, Department of Dermatology, University of Catania School of Medicine, Italy

Giuseppe Micali, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Mudra Kumar, MD, MBBS, MRCP  Associate Professor, Department of Pediatrics, University of South Florida College of Medicine

Mudra Kumar, MD, MBBS, MRCP is a member of the following medical societies: American Academy of Pediatrics and American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

Kevin P Connelly, DO  Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Scabies mite. Courtesy of William D. James, MD.
Scabies mite scraped from a burrow (400 X). Courtesy of Audra Malerba, DO.
Scabies. Courtesy of William D. James, MD.
In patients with crusted scabies, sections show multiple mites (arrows) within the hyperkeratotic stratum corneum. The epidermis is spongiotic (hematoxylin and eosin [H&E], 100 X). Courtesy of Audra Malerba, DO.
In patients with routine scabies, a single mite is observed. Eosinophilic spongiosis may be present (hematoxylin and eosin [H&E], 400 X). Courtesy of Audra Malerba, DO.
In patients with scabies, erythematous vesicles and papules are present on torso extremities, some with adjacent linear excoriations. Courtesy of Audra Malerba, DO.
Scabies on hand. Courtesy of William D. James, MD.
Norwegian scabies. Courtesy of William D. James, MD.
Scabies on leg. Courtesy of William D. James, MD.
Scabies on buttocks. Courtesy of William D. James, MD.
Scabies on penis. Courtesy of William D. James, MD.
Scabies on penis. Courtesy of Hon Pak, MD.
 
 
 
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