Permethrin vs lindane? Which is better?
A 2000 Cochrane review, updated in 2002, concluded that permethrin was superior to lindane for topical treatment of scabies.4,5 Combining 4 trials with 718 patients, permethrin 5% appeared better than lindane 1% (odds ratio=0.66; 95% confidence interval, 0.46–0.95). However, there was significant heterogeneity between the studies, and the largest trial (n=467) found no difference.
Oral ivermectin, though costly, is an effective alternative for those who do not tolerate topical treatment. See the TABLE for a summary of treatment recommendations.
TABLE
Recommended treatment for scabies infection
| DIAGNOSIS | RECOMMENDED THERAPY | SOR |
|---|---|---|
| High-risk individual with exposure | Permethrin 5% topical solution (single overnight application) | A |
| Typical scabies infection | Permethrin 5% topical solution (single overnight application) | A |
| Crusted (Norwegian) scabies | oral ivermectin 200 mcg/kg single dose repeated in 14 days | B |
| Scabies in patient with HIV | Oral ivermectin 200 mcg/kg single dose repeated in 14 days | B |
| Data taken from 2000 Cochrane Systematic Review.4 and 2002 update5 | ||
| SOR, strength of recommendation. | ||
Recommendations from others
Guidelines released by the Centers for Disease Control and Prevention in 2002 regarding the treatment of sexually transmitted diseases state that both sexual and close personal or household contacts of patients diagnosed with scabies within the preceding month should be examined and treated.6
Another guideline, developed by the British Association of Sexual Health and HIV, recommends empiric treatment of sexual, household, and institutional contacts of those with scabies. This guideline recommends treating those who were in contact with the scabies patient within 2 months of his diagnosis; this time frame, though, is arbitrary.7 No evidence grading was given for these recommendations, which are based on expert opinion.