There are several types of antiscabies agents, including:
Permethrin
A neurotoxin that paralyzes and kills ectoparasites. It's applied as a
cream to the entire body, including the face and scalp of infants. It's
left on for 8-12 hours, then rinsed off. Permethrin is especially
effective for treating scabies in infants over two months old and
young children.
Ivermectin
An antiparasitic pill that's usually taken in one or two doses, with a
second dose taken one to two weeks after the first. It's the most
common medication used to treat scabies. However, children under
35 pounds (15 kilograms) and pregnant or nursing people shouldn't
take it.
• Topical Antiscabies agents are intended to target skin for scabies
mainly caused by the mite Sarcoptes scabiei. The mechanism of
action of Antiscabies agents is similar to those produced by
organochlorines, such as DDT, and involves interference with the
axonal sodium gate.
• Medication Summary
• The mainstay of scabies treatment is the application of topical scabicidal
agents, with repeat application in 7 days. The treatment of choice is
permethrin 5% lotion. A 2007 Cochrane Review found that topical
permethrin appeared to be the most effective treatment for
scabies. [69] Alternative drug therapy includes precipitated sulfur 6% in
petrolatum, lindane, benzyl benzoate, crotamiton, and ivermectin; a
possible new option is albendazole. [70, 71, 72, 73] Regarding ivermectin, a
second course of treatment is often recommended 7-10 days later because
of some developing larvae that may survive the initial treatment. [74]
• Pruritus can be treated with an oral antihistamine, such as hydroxyzine
hydrochloride (Atarax), diphenhydramine hydrochloride (Benadryl), or
cyproheptadine hydrochloride (Periactin). More severe symptoms may
require a short course of topical or oral steroids.
• Scabies outbreaks in nursing homes and cases of crusted scabies may
require combination therapy consisting of topical application of permethrin
and 2 oral doses of ivermectin at 200 μg/kg (administered 1 wk
apart). [75] Bullous scabies may respond to ivermectin therapy. [76]
• Observations, however, have noted emerging drug resistance to oral
ivermectin and 5% permethrin. [77] Drug resistance is emerging as a concern
with repeated administration. Clinical resistance has not been documented
for permethrin use, but it has been documented in 2 people with crusted
scabies who had repeated regimens of multiple doses of ivermectin. [7] 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. [78]
• Benzyl benzoate,an ester of benzoic acid and benzyl alcohol, is
neurotoxic to mites and has been used. It is not available in the
United States [9] and is not FDA approved as a scabicide, although it is
used in Europe. [57] There is an unmet need for new acaricide
molecules with greater efficacy and improved pharmacological
profiles to tackle scabies and its morbidity. One such molecule may be
afoxolaner (AFX). It shows efficacy against fleas, ticks, and mites in
dogs, as well as scabies. Controlled studies of the efficacy of scabies
treatments can be difficult to set up, as scabies mites cannot be
maintained or propagated in vitro away from their host for more than
a few days. [79]
