Comparison of topical permethrin 5% vs. benzyl benzoate 25% treatment in scabies: a double-blinded randomized controlled trial

• Published in: British journal of dermatology (1951) Vol. 190; no. 4; pp. 486 - 491
• Main Authors: Meyersburg, Damian, Hoellwerth, Magdalena, Brandlmaier, Matthias, Handisurya, Allesandra, Kaiser, Andreas, Prodinger, Christine, Bauer, Johann W
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 15.03.2024
• Subjects: Acaricides - therapeutic use; Administration, Topical; Animals; Benzoates - therapeutic use; Benzoic acid; Humans; Hygiene; Ivermectin; Parasitic diseases; Permethrin; Permethrin - therapeutic use; Sarcoptes scabiei; Scabies; Scabies - drug therapy
• ISSN: 0007-0963; 1365-2133; 1365-2133
• DOI: 10.1093/bjd/ljad501

Scabies is a pruritic parasitic infestation of the skin. High-income countries have reported an increasing incidence over the last few years. Studies have indicated a reduction in the sensitivity of scabies mites to the standard treatment of choice, topical permethrin 5%. To evaluate in a head-to-head manner the efficacy of two topical scabicides [permethrin 5% and benzyl benzoate 25% (BB)] in the treatment of scabies using the same administration modality; and to address potential confounding factors such as incorrectly performed treatment and hygiene measures. In total, 110 patients with dermoscopy-verified scabies infestation were enrolled and randomized into two equally sized groups in a double-blinded manner. Fifty-five received topical permethrin 5% and 55 received topical BB 25%, both for daily use over a period of three consecutive days. Treatment outcome was evaluated by dermoscopy at a 3-week follow-up visit. Treatment resulted in a dermoscopy-verified cure rate of 27% in the permethrin group and 87% in the BB group. The tolerability and safety profile of permethrin 5% cream was excellent, while the BB emulsion produced a burning sensation in 43% of patients. Topical permethrin demonstrated a lack of efficacy in the majority of scabies cases, whereas BB demonstrated an excellent cure rate and reasonable tolerability. Considering the reduced sensitivity of scabies mites to permethrin 5%, our results suggest that BB is an appropriate first-line therapy in the treatment of scabies.