Community control of scabies: a model based on use of permethrin cream.

For 18 years treatment with lindane or crotamiton products has failed to stem the epidemic of scabies among the Kuna Indians in the San Blas islands of the Republic of Panama. Permethrin 5% cream was introduced as the only treatment in a programme to control scabies on an island of 756 inhabitants and involving workers recruited locally. Prevalence fell from 33% to less than 1% after every person was treated. As long as continued surveillance and treatment of newly introduced cases was maintained, prevalence of scabies remained below 1.5% for over 3 years. When supply of medication was interrupted for 3 weeks, prevalence rose to 3.6%. When control was lost after the US invasion of Panama, prevalence rose to 12% within 3 months. Bacterial skin infections decreased dramatically when scabies was controlled. Permethrin is safe and effective even in areas where this disease has become resistant to lindane.

Permethrin 5% dermal cream: a new treatment for scabies.

Permethrin 5% dermal cream (Burroughs Wellcome Co.) was compared in an investigator-blinded, randomized study against lindane 1% lotion (Kwell) for the treatment of microscopically confirmed scabies. Eleven of twenty-three patients treated with permethrin cream were cured in 2 weeks (48%). Only two patients had scabies 1 month following a single treatment with this product, giving a cure rate of 91%. One of these two patients was considered to have a reinfestation. Only three of twenty-three (13%) patients treated with 1% lindane lotion (Kwell) were free of scabies 2 weeks after a single treatment and fifteen of twenty-three (65%) were cured at 1 month. The unusually high percentage of treatment failures (35%) following lindane therapy may have been related to extensive use of this agent for head lice and scabies in this village during the preceding 5 years. The higher cure rate at 1 month seen with permethrin cream was significant (p less than 0.025). Permethrin 5% dermal cream offers a new, cosmetically elegant alternative to lindane therapy and was effective in a community in which lindane demonstrated an unacceptable level of treatment failures.

Permethrin 1% creme rinse for the treatment of Pediculus humanus var capitis infestation.

Permethrin 1% creme rinse (NIX) was tested as a treatment for Pediculus humanus var capitis (head lice) in a placebo-controlled, double-blinded, randomized study. As a positive control, a third arm of the study included nonrandomized, but investigator-blinded, treatment with 1% lindane shampoo (Kwell). At 14 days after treatment, 97% of patients treated with permethrin were free of lice compared to 6% of placebo-treated patients (P less than 0.001) and 43% of the lindane-treated group. Permethrin was 70% ovicidal compared to 14% for placebo (P less than 0.001) and 45% for lindane. No adverse experiences were noted during this study. Permethrin 1% demonstrated high pediculicidal and ovicidal activities, which in combination with its low mammalian toxicity, residual activity, and cosmetic properties, make it an excellent treatment for pediculosis capitis.

Malathion for treatment of Pediculus humanus var capitis infestation.

One hundred fifteen subjects took part in a double-blind study comparing the efficacy and safety of 0.5% malathion lotion (Prioderm lotion) and the alcoholic vehicle of the lotion as pediculicides in the treatment of head lice. The subjects, with a mean age of 9 years, had long-standing lice infestations and at least 20 viable ova. The subjects were treated with the test preparation, which was allowed to remain on the hair for 12 hours. Ovicidal and pediculicidal efficacy for the malathion lotion was significant; overall clinical evaluation by the investigators showed a significant number of moderate to marked therapeutic responses to malathion lotion. Only one adverse reaction (in the malathion lotion group) was reported, the stinging of pyodermal lesions in reaction to the alcoholic vehicle. Other concomitant scalp diseases were unchanged or improved at the end of the study.