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Microscopic clearance with ivermectin-permethrin combination vs. permethrin alone in noncrusted scabies: a
Ye Ji Kim1, Su Min Kim1, Hyun Chul Jung1
1Department of Dermatology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
Background:
Scabies is a common problem in dermatology clinics, with an increasing burden in long-term care hospitals (LTCHs). Recent guidelines recognize both topical 5% permethrin and oral ivermectin as first-line treatment options for noncrusted scabies, whereas combination therapy is primarily recommended for crusted scabies. Management in routine practice remains challenging, particularly in patients with a heavier infestation, and evidence supporting combination strategies in noncrusted scabies remains limited.
Objectives:
To evaluate real-world microscopic treatment outcomes of oral ivermectin plus topical permethrin compared with permethrin monotherapy, including time to microscopic cure and microscopic persistence at weeks 2 and 4.
Methods:
We conducted a retrospective cohort study of 429 outpatients with microscopically confirmed noncrusted scabies at a single Korean centre (2018-25). Patients received weekly topical permethrin plus oral ivermectin (200 µg kg-1) (n = 204) or topical permethrin alone (n = 225) according to routine clinical practice.
Results:
Time to microscopic cure was shorter with combination therapy than with monotherapy [mean 2.10 (SD 0.90) vs. 2.31 (SD 1.09) weeks, P = 0.03]. At week 2, microscopic persistence occurred in 30.4% (62/204) of the combination group and 35.1% (79/225) of the monotherapy group (P = 0.35). By week 4, persistent positivity occurred only in the monotherapy group [0% (0/204) vs. 3.1% (7/225), P = 0.02].
Conclusions:
In a real-world outpatient setting, ivermectin-permethrin combination therapy was associated with earlier microscopic clearance than permethrin monotherapy. These findings suggest that combination therapy may be considered in selected patients with a heavier infestation or in settings where rapid parasitological clearance is a priority.
