Pharmacology and Therapeutics

Treatment of Scabies:

Preliminary Report

MOHAMED AMER, M.D. , MOHAMED EL-BAYOUMI, M.D. , AND MOHAMED K. RlZK, M.D.

ABSTRACT: Five topical treatments for scabies compared forefficacy in 85 infants with scabetic infestation. Preliminary re-sults during the six-month study period showed lindane to bethe most effective, with furacin the least effective.

Despite the current epidemic of scabies, there hasbeen limited interest in comparative controlled efficacytrials of scabicides.' Most of these studies were doneduring the last epidemic. Pierce^ studies 500 patientswith scabies in 1951 and concluded that one applicationof lindane was slightly superior to one application of theother preparations, including crotamiton and benzylbenzoate, in terms of high cure rate and low localreactions.

Case Reports

Eighty-five infants with scabies were entered into the study atthe Department of Dermatology at Banha Hospital of ZagazigUniversity during a period of six months. Their ages rangedfrom three weeks to one year. The disease duration rangedfrom one to six weeks at the time of initial presentation. Diag-nosis was based on the clinical features, including the mor-phology and distribution of lesions, nocturnal itching, and ir-ritability, and the presence of contact cases. No scrapings weredone.

The subjects were classified into five groups, each receivinga different treatment schedule.

Group 1: 22 cases, received sulfur ointment 5%, appliednightly for four nights

Group 2; 20 cases, received lindane cream 1%, appliednightly for two successive nights.

Presented at the Eirst Zagazig International Conference on Der-matology, June 21-24, 1980, Zagazig, Egypt.

Address for reprints: Mohamed Amer, M.D., Department of Der-matology, Zagazig University Faculty of Medicine, Zagazig, Egypt.

From the Department of Dermatology,Zagazig University Faculty of Medicine,

Zagazig, Fgypt

Group 3: 17 cases, received benzyl benzoate cream 25%,applied for two successive nights.

Group 4: 16 cases, received crotamiton lotion 10%,applied for three successive nights.

Group 5: 10 cases, received furacin (soluble ointment ofnitrofurazone 0.2% W/W in water-soluble base),applied for three successive nights.

Members of each infant's families were treated at the sametime with the same scabicide. Patients were seen seven days,after the initial visit for assessment of drug efficacy, occurrenceof side effects, and further treatment as required. Nonrespond-ing cases were given a second course of the same drug. As-sessments were done clinically. Histologic and microscopicevaluations were not done.

Results

The results are illustrated in Table 1.

TABLE 1.

No. of 1st Course 2nd CourseTable Cure

Group Cases Cure (Cases) Cure (Cases) No.

1. sulfur2. lindane3. benzyl benzoate4. crotamiton5. furacin

222017

16.10

15161211

7

3 181 171 132 13

— 7

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0011-9059/81/0500/0289/$00.60 © International Society of Tropical Dermatology, Inc.

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290 INTERNATIONAL JOURNAL OF DERMATOLOGY May 1981 Vol. 20

Discussion

Many scabicides have been used since antiquity. Cel-sus (Ca. 25 AD) recommended sulfur mixed with liquidpitch as a remedy for the itch.^ Shoemaker'' in 1898 usedchlorine water, balsam of Peru, potassium carbonate,phenol, and even mercurials, but he recommendednaphthol ointment as the best treatment for scabies.Since the last epidemic of scabies, Iindane has becomethe major scabicide.

In the present study, the highest cure rate was ob-tained with Iindane (85%). No side effects were ob-served from this drug. Furacin produced the least per-centage of cure. The drug has been used by Chowdhury^in the treatment of 30 Bangladesh scabetics having sec-ondary bacterial infection, with complete clinical curein 80%. The mode of action of this drug in scabies is notclear. We are not yet sure whether the drug is scabicidalor patient selection. These cases were chosen to havemarked secondary bacterial infection (impetigo,pyoderma, frunculosis) in hopes of controlling both themite and the infection. Significant secondary bacterialinfection may cure scabies since the mite cannot survivethe infected skin.^

None of the scabicides used in the present work hasproduced a 100% cure rate. Possibly, not all patientshad scabies, as scrapings were not done. Probably thisfinding is one of the characteristics of the present

epidemic. Hurwitz^ states that the response to therapy inthe present epidemic frequently is not as prompt andclear cut as it was prior to 1950. Resistance to scabicideshas been suggested but not conclusively proven, and isunlikely.*

Conclusions

Additional studies under more controlled cir-cumstances are being instituted in order to obtain morestatistical significant data and to observe patients for anyside effects for an extended period of time.

References

1. Orkin M, Maibach HI: Scabies in children. In: Symposium onPediatric Dermatology. Edited by Jacobs AM. Pediatr Clin NAm 25:371, 1978

2. Pierce HE: Scabies: Epidemiology and management at correc-tional institution. J NatI Med Assoc 43:107, 1951

3. Heilesen B: Studies on Acarus Scabiei and scabies. Acta DermVenereol 26 (suppl):14, 1946

4. Shoemaker JV: A Practical Treatise on Diseases of the Skin, 3rded.Appleton, New York, 1898

5. Chowdhury SPR: Nitrofurazone in scabies. Lancet i:152, 19776. Mellanby K: The development of symptoms, parasitic infection

and immunity in human scabies. Parasitology 35:197, 19447. Hurwitz S: Scabies in infants and children. In: Scabies and

Pediculosis. Edited by Orkin M, Maibach HI, Parish LC,Schwartzman RM. Philadelphia, JB Lippincott, 1977, p 31

8. Pace WE, Purres |: Resurgence of scabies. Can Med Assoc J104:719, 1971

Basal Cell Cancer

That passage from Ecclesiastes danced across my mind as 1 read the report by Satinoff & Wells(1969). Ten years earlier Dr. Caro and I had described a constellation of defects that has since becomeknown as the naevoid basal cell carcinoma (NBCC) syndrome. Its principle features are multiple basalcell carcinomas that tend to appear early in life, jaw cysts, pits of the hands and feet, skeletalanomalies, and ectopic calcification. In their report, Satinoff & Wells (1969) described skeletalanomalies that supported a diagnosis of NBCC syndrome in two cases—but their "patients" were twoancient Egyptian skeletons who lived during the dynastic period.

What we now call the NBCC syndrome had obviously been with humanity over the ages, butrecognition of it as a separate entity awaited a convergence of the accumulation of centuries ofmedical knowledge, the powers of modern technology, and man's God-given powers of observation.To their fellow Egyptians, these two men simply had skin tumours, which continued to grow anddevour their faces, strange pits on their hands and feet, and recurring infections in their jaws. Observa-tion of the associated skeletal anomalies had to be postponed until the forces of time had laid thebones bare.

The skin tumours of the NBCC syndrome are unusual and have attracted the attention of inquisitiveclinicians for years. Histologically the tumours are similar to epithelioma adenoides cysticum, butclinically they behave like rodent ulcers. Nevertheless, such tumours were usually labelled asepithelioma adenoides cysticum with transformation into multiple rodent ulcers. This viewpointprevailed until Dr. Caro and I proposed that these tumours were unique and that they were one of agroup of signs and symptoms that characterized a previously unrecognized syndrome.—Howeli IB:The roots of the naevoid basal cell carcinoma syndrome. Clin Exp Dermatol 5:339, 1980