A narrative review of the roles of topical permethrin and oral ivermectin in the management of infantile scabies

Abstract

As standard treatments are not licensed for use in the infantile population, the treatment of scabies in this age group can be challenging. We review the relevant evidence to determine the roles of topical permethrin and oral ivermectin in the management of infantile scabies. Demographic and clinical data were collected from relevant English articles published from January 2000 to December 2020. Complete resolution was observed in 100% of infants younger than two months treated with permethrin, and 87.6% of infants aged 12 months or less and/or children weighing under 15 kg treated with ivermectin. Adverse effects from permethrin use were limited to local eczematous reactions. Adverse effects from ivermectin use included mildly elevated creatine kinase levels, eczema flare-ups, diarrhoea, vomiting, irritability, pruritus and pustular skin reactions. Overall, both permethrin and ivermectin appear to have an acceptable safety profile in infants. Permethrin is highly effective as a first-line therapy for scabies in infants younger than two months. Ivermectin use is recommended when authorised topical treatment has failed, in crusted scabies, in cases where compliance with topical agents may be problematic, and in infants with severely inflamed or broken skin where prescription of topical therapies would likely cause cutaneous and systemic toxicity. Additional high-quality studies are needed to guide best practice in the management of infantile scabies.

Disseminated scabies in a 2‐month‐old infant

“…1 , 7 In the complex cases, oral ivermectin is considered safe for treatment. 7 , 8 Oral antihistamines can be recommended to alleviate pruritus and post‐scabetic itch. 7 , 8 …”

“…1,7 In the complex cases, oral ivermectin is considered safe for treatment. 7,8 Oral antihistamines can be recommended to alleviate pruritus and post-scabetic itch. 7,8 Taken together, differential diagnosis of scabies should be made from other dermatitis, especially in infant and children.…”

“…Topical permethrin 5% lotion is best achieved pharmacological management of pediatric patients with uncomplicated classic scabies 1,7 . In the complex cases, oral ivermectin is considered safe for treatment 7,8 . Oral antihistamines can be recommended to alleviate pruritus and post‐scabetic itch 7,8 …”

The currently available diagnostic tools and treatments of scabies and scabies variants: An updated narrative review

“…[23] Permethrin 5% cream is applied overnight from the scalp to toes, avoiding the skin of periorbital and perioral locations, and washed off after 8 to 12 hours and then it must be repeated after 7 to 14 days. [14,19] The second application is used to eliminate newly hatched mites, as the first application is not always effective in eliminating all the eggs. [13] Permethrin 5% cream is FDA-approved and is safe during pregnancy and lactation and in children at the age of 2 months and older.…”

“…[25] Adverse effects are reported infrequently, generally mild, and confined to local cutaneous reactions like transient paresthesia, irritation, erythema, dryness, burning sensation, pruritus, eczema, and contact dermatitis. [7,8,14] 4.1.2. Ivermectin.…”