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Scabies: Diagnostic and Therapeutic Update.

Robert N Richards1

  • 18613 Departments of Medicine, North York General Hospital and Baycrest Health Sciences, Courtesy Staff Dermatology, Toronto, ON, Canada.

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|October 1, 2020
PubMed
Summary

Oral ivermectin offers a safe, effective, and economical alternative to topical treatments for scabies, especially in institutional settings and for crusted scabies. This oral medication simplifies treatment for large populations and improves adherence.

Keywords:
crusted scabiesinstitutional scabiesivermectinpermethrinpopulation outbreaksscabies

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Area of Science:

  • Dermatology
  • Infectious Diseases
  • Public Health

Background:

  • Scabies is a widespread parasitic skin infection, posing significant challenges in institutional settings and resource-limited areas.
  • Topical treatments for scabies are often difficult to administer in large populations and for non-adherent individuals.
  • Oral ivermectin has become available for off-label scabies treatment in Canada since 2018.

Purpose of the Study:

  • To review the diagnostic approaches and management strategies for scabies.
  • To outline dosing regimens and concurrent management for scabies simplex and crusted scabies.
  • To detail the use of oral ivermectin in scabies treatment.

Main Methods:

  • Literature review utilizing Medline database.
  • Discussions with colleagues and review of clinical practices.
  • Experience gained from managing institutional scabies outbreaks.

Main Results:

  • Oral ivermectin demonstrates superior safety, ease of use, cost-effectiveness, and efficacy compared to topical agents.
  • It is particularly advantageous for widespread institutional scabies, non-adherent patients, and crusted scabies cases.
  • The oral route simplifies treatment administration and improves patient compliance.

Conclusions:

  • Oral ivermectin is the preferred treatment for scabies in large populations, non-adherent individuals, and crusted scabies.
  • Recommended dosage for non-crusted scabies is 200 µg/kg once, with a repeat dose in 10-14 days.
  • Merck Canada produces oral ivermectin as Stromectol 3 mg.