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Scabies is an ectoparasitic, highly contagious skin disease caused by a mite called Sarcoptes scabiei. The insecticides ivermectin and permethrin are commonly used for treatment of scabies. This study aimed at comparing the efficacy of oral ivermectin with topical permethrin in treating scabies. Two hundred and forty-two patients with scabies attending the dermatology outpatient department of Sina Hospital, Tabriz University of Medical Sciences were admitted. Patients were divided into two groups randomly. The first group and their family contacts received 5% permethrin cream and the other received oral ivermectin. Treatment was evaluated at intervals of 2 and 4 weeks.
A single dose of ivermectin provided a cure rate of 85.9% at a 2-week interval, which increased to 100% after crossing over to the permethrin group at a 4-week interval. Twice application of permethrin with a 1-week interval was effective in 92.5% of patients, which increased to 94.2% after crossing over to the ivermectin group at a 4-week interval. Permethrin-treated patients recovered earlier. Twice application of permethrin with a 1-week interval is superior to a single dose of ivermectin. The temporal dissociation in clinical response suggests that ivermectin may not be effective against all the stages in the life cycle of the parasite.
The incubation period for scabies is about three weeks, but reinfestation can occur much faster. The main symptom is itching, which is worse at night. In older children and adults, the main areas infested are the web spaces between the fingers, the flexor aspect of the wrists and elbows, the axillae, male genitalia and women’s breasts. Skin scrapings are used to make a definitive diagnosis, if they are taken from the burrows or other lesions and examined under a low power microscope. Mites, feces or eggs can be seen on the microscope slide; however, the diagnosis is usually made clinically, rather than by microscope.
Scabies is associated with an infestation of the skin by an epidermal-dwelling mite, Sarcoptes scabiei. It is a highly contagious condition that is primarily transmitted through close contact and rarely through exposure to infested clothing, bedding, or other household items. Patients typically present with symptoms 7 days after the first exposure, but may develop skin lesions as early as 3-4 days after subsequent exposures. Skin lesions are usually intensely pruritic, with the exception of infants, elderly, and other individuals who have neurologic disease or immunocompromised status. A rare form, crusted scabies, can be generalized. Risk factors for scabetic infestation include crowded living conditions, health care facilities, and institutions.