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Results: The present study compared three scabicidal agents alone or with combination, the currently considered medicine of choice permethrin, oral ivermectin, and gamma benzene hexachloride in the local population of India. A total of 120 patients were studied. They were randomly divided into four groups -Group A, Group B, Group C, and Group D. Group A received topical 5% permethrin and oral placebo. Group B was given topical placebo cream and oral ivermectin in two dose regimen. Group C received topical 1% gamma benzene hexachloride with oral placebo, and Group D was given topical 5% permethrin and oral ivermectin. The improvement of lesions and pruritus were assessed in the next three follow-ups, i.e., on the 7th day, 14th day, and 28th day along with any adverse drug reactions (ADRs). It was found that Group A had 83%, 90%, 97%, and Group B had 70%, 81%, and 91% improvement of lesions in the three follow-ups respectively. Group C showed 57%, 70%, 86%, and Group D had 82%, 90%, 97% efficiency to decrease lesion count (p>0.05) respectively. Again, Group A observed 77%, 88%, and 94% improvement in pruritus in subsequent follow-ups, while for Group B it was 63%, 76%, and 86%. Group C had 55%, 71%, 85% efficiency, and Group D had recorded 77%, 88%, and 94% improvement to decrease pruritus (p>0.05). The incidence of adverse effects was found to be less in Group B, Group C, and Group D when compared to Group A., Conclusion: Group D or a combination therapy was a better choice for scabies in comparison to other monotherapy due to its better efficacy and safety profile., Competing Interests: None

Scabies, whose etiologic agent is Sarcoptes scabiei, is a neglected parasitic disease that is a major public health problem in many resourcepoor regions. Its current therapies include benzyl benzoate, lindane, permethrin, sulfur, crotamiton, monosulfiram, and oral ivermectin. The aim of this study was to compare the efficacy and safety of lindane 1% lotion vs permethrin 5% in the treatment of scabies. A total of 120 patients with scabies attending a dermatology outpatient department were included. Patients were randomly divided into two groups. Sixty patients and their family contacts received 5% permethrin cream and the other 60 received 1% lindane lotion. Treatment was evaluated at intervals of 2 and 4 weeks. Permethrin provided improvement in 48 patients (80%) after 2 weeks, whereas lindane was effective in only 28 patients (46.6%). Permethrin (5%) cream was found to be significantly more effective in the treatment of scabies compared with lindane in this study. Adverse effects were rare in both the permethrin and lindane groups.

Background: This is the first study investigating scabies treatment since 1992 to involve examination of patients with microscopically confirmed scabies., Aim: To assess the efficacy of 1% lindane cream in treating microscopically confirmed scabies, and to determine the utility of dermoscopy-guided skin scraping with microscopic examination (DSGSS-ME) in evaluating the efficacy of scabies treatment., Methods: This retrospective study analysed patients treated for scabies between January 2012 and December 2013. From the hospital database, 287 cases of scabies were identified and 50 were enrolled in the study. Patients were treated with 1% lindane cream twice weekly (days 0 and 1) and were evaluated with DSGSS-ME on day 7. Treatment and evaluations were repeated once weekly until a negative DSGSS-ME result was obtained., Results: The cumulative efficacy of lindane 1% cream was 40% (20/50) after 1 week, 88% (44/50) after 2 weeks and 98% (49/50) after 3 weeks of treatment. There was a statistically significant difference between the 1- and 2-week (P = 0.03), and 1- and 3-week (P = 0.02) treatments. A total of 90 post-treatment DSGSS-MEs were performed, with a sensitivity of 97.3% (95% CI 85.8-99.9) and a negative predictive value of 98.2% (95% CI 90.1-100). Specificity and positive predictive value were 100%, as this procedure cannot yield false-positive results, because it relies on finding mites, eggs or faeces., Conclusions: We suggest that a twice-weekly schedule (on consecutive days) of 1% lindane treatment lasting at least 2 weeks is required to clear scabies. DSGSS-ME appears to be a good method to evaluate the efficacy of scabies treatment. This study introduces a safe and effective method to treat scabies, and to accurately monitor infestation status in patients., (© 2015 British Association of Dermatologists.)

Lindane (gamma benzene hexachloride) is a widely prescribed topical scabicide because of its efficacy and cost-effectiveness. Although toxicity from a single proper application of lindane is generally not observed, the hazards of repeated applications, industrial exposure, and accidental ingestion have been well documented. We herein describe an infant with reversible neurotoxicity following repeated applications of 1% lindane for the treatment of scabies. The role of factors predisposing to increased absorption and the recommendations to minimize potential neurotoxicity are emphasized.

Scabies is a common, highly pruritic infestation of the skin caused by Sarcoptes scabiei var. Hominis. It is a very contagious parasitosis with specific lesions, such as burrows, and nonspecific lesions, such as papules, vesicles and excoriations. The typical areas of the body it affects are finger webs, wrists, axillary folds, abdomen, buttocks, inframammary folds and, in men, the genitalia. It is characterized by intense nocturnal pruritus. Scabies is spread through close personal contact (relatives, sexual partners, schoolchildren, chronically ill patients and crowded communities). Definitive diagnosis is made when the scabies mites or their eggs or fecal pellets can be identified on a light microscope. New techniques for diagnosis include the use of the epiluminiscence microscopy. The most common topical treatments for scabies include lindane and permethrin. Permethrin provides a greater margin of tolerability because of its low inherent toxicity and low percutaneous absorption. Oral ivermectin is the most recently developed treatment for scabies. A single oral dose of ivermectin 200 microg/kg of bodyweight is a well-tolerated and very effective treatment. It is especially indicated in crusted scabies, scabies in immunocompromised hosts and infestations in crowded communities. It is also useful as a simple treatment in the prophylaxis of close contacts.

Scabies is a common infestation for patients of all ages throughout the world. One of the standard therapies for scabies is 1% lindane lotion. Lindane has been associated with neurotoxic reactions, specifically seizures. We describe a case of a middle-aged adult man with human immunodeficiency virus (HIV) infection who was found to have typical scabies and was treated with a single topical application of lindane. Two hours after the application, the patient experienced a new-onset generalized seizure. We believe that the triad of HIV infection, medications that reduce seizure thresholds, and percutaneous absorption factors, in the aggregate, induced the seizure. We believe that lindane should not be prescribed for patients with HIV infection.

Scabies is highly contagious and is usually transmitted by direct personal contact. It typically presents as an intensely pruritic eruption. Atypical presentations are common in Norwegian scabies and in childhood scabies. Infestation is documented by visualizing the mite, its eggs or scybala on low-power microscopy. The treatment of choice is 5 percent permethrin cream, used in a single application at bedtime and removed the next morning.

Crusted (Norwegian) scabies, a rare variant of ordinary scabies, is a highly contagious infection in which the skin is infested with thousands to millions of mites. The infection is frequently overlooked because of its atypical presentations. Patients with cognitive deficiency or an immunodeficiency disorder (including immunosuppressive therapy) are predisposed to developing crusted scabies. The infection often presents as generalized dermatitis with crusted hyperkeratosis on the palms and soles. Diagnosis is made by examining skin scrapings from the crusted lesions. Lindane is the scabicide most widely used in the treatment of crusted scabies. Eradication frequently requires repeated applications, and care must be taken to avoid lindane toxicity. Permethrin cream is as efficacious as lindane in the treatment of ordinary scabies. Because of its wider margin of safety, permethrin may become the preferred treatment for crusted scabies.

Numerous toxic exposures have been implicated in causing aplastic anemia. Thirteen cases of aplastic anemia and 5 cases of other blood dyscrasias, eg, red blood cell aplasia and thrombocytopenia, associated with lindane, have been reported in the literature. However, aplastic anemia secondary to the scabicidal product (lindane [Kwell]) has not been documented, to our knowledge. We present the case of a 21-year-old man with a diagnosis of aplastic anemia, known prolonged exposure to lindane, and documented elevated serum lindane levels. His clinical course is described as well as various defects are explored for the aplasia.

Risks and benefits involved in the use of lindane preparations for the treatment of scabies and head louse infestations are evaluated. Although lindane per si is moderately toxic, capable of inducing neurotoxic and hemotoxic effects, there is little evidence that the preparations used in the treatment of scabies and pediculosis give rise to toxic symptoms when applied according to directions. Current evidence does not support the view that lindane is intrinsically carcinogenic, although very high doses have induced hepatomas in mice. It is concluded that the benefits obtained in the use of lindane as a scabicide and pediculicide outweigh risks involved in its use for these purposes. Comparison with other preparations available for the control of scabies and pediculosis indicate that lindane is probably the most effective scabicide, although it also shows the greatest toxic potential. Malathion and pyrethrin preparations seem equally effective against head lice. Suggestions for even safer use of lindane are discussed.

In the years 1980-1981 we treated 112 cases of scabies with 20% sulphur ointment, or 1% lindane. In 18% irritative contact dermatitis occurred after the treatment.

This open clinical study was designed to evaluate and compare the efficacy and side effects of lindane (1% and 0.3%), benzyl benzoate (20% and 10%) and permethrin (5% and 2.5%) after two, three, and one application at bedtime, in the treatment of scabies in 114 adults and 80 children aged between 0 and 5 years. Treatment failures were registered after lindane in 3 adults and 2 children, whereas benzyl benzoate and permethrin cured all patients as assessed after a 3-week follow-up. The number of irritations and post-scabious eczematous reactions was increased after benzyl benzoate treatment. Permethrin proved to be very reliable and exhibited few side effects when applied once at bedtime. Because of the percutaneous absorption and neurotoxicity of lindane, the application of permethrin can be recommended as a useful alternative in premature infants and small children, patients with seizures and neurological complications, in cases of therapeutic failure with lindane the treatment needs to be repeated, in scabies crustosa, as well as in children, pregnant women and nursing mothers.

A 3-year-old boy with nonbullous congenital ichthyosiform erythroderma with a four-month history of scabies was treated with a single dose of lindane cream. In a 48-hour period, he developed nausea and vomiting and also suffered from an epileptiform convulsion and muscular spasms. Seventy-two hours after application of the cream, his blood lindane level was 54 ng/mL. Caution should be exercised when using lindane in patients with compromised epidermal barrier function.

Treatment for scabies is usually initiated by general practitioners; most consider lindane (gamma benzene hexachloride) the treatment of choice. Lindane is also widely used as an agricultural and industrial pesticide, and as a result the toxic profile of this insecticide is well understood. Evidence is accumulating that lindane can be toxic to the central nervous system and may be associated with aplastic anaemia. Preparations containing lindane continue to be sold over the counter and may represent a hazard to poorly informed patients. This literature review suggests that general practitioners should prescribe scabicides with increased caution for certain at-risk groups, and give adequate warnings regarding potential toxicity.

Scabies and pediculosis, two commonly encountered infestations both having an incidence that is on the rise, are discussed in detail in this article with special emphasis given to their symptomatology, pathogenesis, and treatment.