Comparison of Topical 5% Permethrin and Topical 10% Sulfur in the Treatment of Scabies
Condition: Scabies
MeSH terms: Scabies
Study type: Interventional
Phase: Phase 1

Summary: 
      Sarcoptes scabiei is responsible for a skin infection called scabies. Permethrin is most
      widely used anti-scabicidel drug and is taken as drug of choice because of its efficacy,
      safety and patient's compliance. Sulfur 6-33%, as cream, ointment or lotion, is recommended
      by the European guidelines as an effective alternative treatment and is among the oldest
      treatments used for scabies. It is recommended to be applied for 3 consecutive days.

      Both permethrin and sulfur have been shown in previous studies to be superior to other
      anti-scabietic drugs in terms of efficacy. Two studies showed that permethrin was more
      efficacious than sulfur, whereas a single study showed otherwise. Therefore, only a few
      studies are available to find a direct comparison of the efficacy of topical 5% permethrin
      and topical 10% sulfur in the treatment of scabies and none of them have been carried out in
      Pakistan. The objective of the study is to compare the efficacy of topical 5% permethrin
      cream and sulfur 10% ointment in the treatment of scabies.
    

Detailed description: 
      The mite named as Sarcoptes scabiei is responsible for a skin infection called scabies. This
      parasite is a tiny mite that is commonly not visible without a microscope and is present at
      stratum corneum level in the skin. It burrows in the patient's skin and causes this
      contagious infection.

      Permethrin is an insecticide that kills the mites and permethrin 5% cream is among the
      commonly used drugs for scabies. It is most widely used and taken as drug of choice because
      of its efficacy, safety and patient's compliance. European guidelines for the management of
      scabies recommend 5% permethrin cream to be applied from head to toe for 8-12 hours before
      washing it off and treatment to be repeated after 7 to 14 days. Sulfur 6-33%, as cream,
      ointment or lotion, is recommended by the European guidelines as an effective alternative
      treatment and is among the oldest treatments used for scabies. It is recommended to be
      applied for 3 consecutive days. Topical Sulfur 5-10% ointment (precipitated sulfur) is among
      the safe and cost effective treatment options for scabies. The toxicity of sulfur ointment is
      low and therefore can be used in pregnancy and in children. Efficacy ratio although not very
      clear from previous data now shows that it cures scabies especially the type called Norwegian
      scabies. It is recommended to be applied on whole body for 3 successive days.

      A lot of therapeutic options have been used to treat scabies but still there is a need to
      study those drugs for their efficacy and duration of treatment to eradicate the scabies
      completely from the patients and their environment. In a study done in 1994, when the use of
      permethrin was not very common, there were reports of killing the mites within one hour in
      vitro but in year 2000, it was reported that 35% mites were still alive even after 3 hours.
      Both permethrin and sulfur have been shown in previous studies to be superior to other
      anti-scabietic drugs in terms of efficacy. Two studies showed that permethrin was more
      efficacious than sulfur, whereas a single study showed otherwise.

      Therefore, only a few studies are available to find a direct comparison of the efficacy of
      topical 5% permethrin and topical 10% sulfur in the treatment of scabies and none of them
      have been carried out in Pakistan. The objective of the study was to compare the efficacy of
      topical 5% permethrin cream and sulfur 10% ointment in the treatment of scabies. The
      hypothesis of the study was that there is a significant difference in efficacies of 5%
      permethrin cream and 10% sulfur ointment in the treatment of scabies. The study will help the
      dermatologists to develop better drug treatment strategies for their patients, and will also
      assist in curbing the spread of this disease to the community hence reducing its burden.
    

Intervention name(s): Permethrin; Sulphur
Intervention type(s): Drug; Drug
Intervention description(s): 5% permethrin cream; 10% Sulfur ointment
Other intervention name(s): Lotrix; Scabion
Intervention MeSH terms: Permethrin
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: scabies; permethrin; ointment; therapeutics