Interventions for treating scabies

 

Abstract

Background

Scabies is an intensely itchy parasitic infection of the skin caused by the Sarcoptes scabiei mite. It is a common public health problem with an estimated global prevalence of 300 million cases. Serious adverse effects have been reported for some drugs used to treat scabies.

Objectives

To evaluate topical and systemic drugs for treating scabies.

Search methods

In June 2010, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE, EMBASE, LILACS, and INDMED. In August 2010, we also searched the grey literature and sources for registered trials. We also checked the reference lists of retrieved studies.

Selection criteria

Randomized controlled trials of drug treatments for scabies.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. Results were presented as risk ratios with 95% confidence intervals and data combined where appropriate.

Main results

Twenty-two small trials involving 2676 people were included. One trial was placebo controlled, 18 compared two or more drug treatments, three compared treatment regimens, and one compared different drug vehicles.

Fewer treatment failures occurred by day seven with oral ivermectin compared with placebo in one small trial (55 participants). Topical permethrin appeared more effective than oral ivermectin (140 participants, 2 trials), topical crotamiton (194 participants, 2 trials), and topical lindane (753 participants, 5 trials). Permethrin also appeared more effective in reducing itch persistence than either crotamiton (94 participants, 1 trial) or lindane (490 participants, 2 trials). No difference was detected between permethrin (a synthetic pyrethroid) and a natural pyrethrin-based topical treatment (40 participants, 1 trial), and between permethrin and benzyl benzoate (53 participants, 1 trial), however both these trials were small.

No significant difference was detected in the number of treatment failures between crotamiton and lindane (100 participants, 1 trial), lindane and sulfur (68 participants, 1 trial), benzyl benzoate and sulfur (158 participants, 1 trial), and benzyl benzoate and natural synergized pyrethrins (240 participants, 1 trial); all were topical treatments. No trials of malathion were identified.

No serious adverse events were reported. A number of trials reported skin reactions in participants randomized to topical treatments. There were occasional reports of headache, abdominal pain, diarrhoea, vomiting, and hypotension.

Authors' conclusions

Topical permethrin appears to be the most effective treatment for scabies. Ivermectin appears to be an effective oral treatment. More research is needed on the effectiveness of malathion, particularly when compared to permethrin, and on the management of scabies in an institutional setting and at a community level.

 

Plain language summary

Interventions for treating scabies

Scabies is a parasitic infection of the skin. It occurs throughout the world, but is particularly problematic in areas of poor sanitation, overcrowding, and social disruption, and is endemic in many resource-poor countries. The global prevalence of scabies is estimated at 300 million cases, but the level of infection varies between countries and communities. The female mite burrows into the skin to lay eggs which then hatch out and multiply. The infection can spread from person to person via direct skin contact, including sexual contact. It causes intense itching with eruptions on the skin. Various drugs have been developed to treat scabies, and herbal and traditional medicines are also used. The review of trials attempted to cover all these. The authors identified 22 small trials involving 2676 people, with 19 of the trials taking place in resource-poor countries. Permethrin appeared to be the most effective topical treatment for scabies, and ivermectin appeared to be an effective oral treatment. However, ivermectin is unlicensed for this indication in many countries. Adverse events such as rash, vomiting, and abdominal pain were reported, but the trials were too small to properly assess serious but rare potential adverse effects. No trials of herbal or traditional medicines were identified for inclusion.

 

摘要

背景

治療疥瘡的方式

疥瘡是一種極癢的寄生蟲皮膚感染,由一種蝨子(Sarcoptes scabiei)感染。它是常見公共衛生問題而全球盛行率約三億病例。某些治療疥瘡的藥物已被報告具有嚴重的副作用。

目標

去評估治療疥瘡局部性和全身性治療藥物。

搜尋策略

在2007年2月,我們收集了Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE, EMBASE, LILACS, INDMED。在2007年3月我們也收尋灰色文獻(grey literature)和已註冊的臨床試驗。我們也查核了這些研究的參考文獻。

選擇標準

疥瘡藥物治療的隨機控制研究試驗。

資料收集與分析

2名作者分別評估試驗品質併摘取資訊。只要適宜資料便會彙集一起分析,最後結果以相對危險及95%信心區間呈現。

主要結論

20個小型試驗共有2392人參與。其中1個試驗是安慰劑的比較,16個試驗比較2種或多種藥物,2個比較不同處方,1篇比較不同藥物載體(vehicles)。在一篇55人參與的小型研究中口服ivermectin治療7天後有少數治療失敗。局部permethrin治療比下列研究有效,包括口服ivermectin(1篇研究85位病人),局部crotamiton(2篇研究194位病人),局部lindane(5篇研究753位病人)。Permethrin在與下列研究比較下也顯示降低皮膚搔癢程度會更有效,包括crotamiton(1篇研究94位病人)或lindane(2篇研究490位病人)。在一篇小型研究(40位病人)中,並不能發現permethrin(合成的pyrethroid)與天然局部的pyrethrin有何差異。在治療失敗數目未有任何臨床意義的差異有crotamiton與lindane(1篇研究100位病人), lindane與sulfur(1篇研究68位病人), benzyl benzoate與sulfur(1篇研究158位病人), benzyl benzoate與natural synergized pyrethrins(1篇研究240位病人),以及所有表面塗劑。沒有人任何關於使用malathion的研究。沒有嚴重副作用被報告。有一些臨床試驗報導在表面塗劑組會發生一些皮膚反應。偶爾有些頭痛,腹痛,腹瀉,嘔吐,低血壓的報導。

作者結論

局部擦抹permethrin顯然對疥瘡治療最有效。口服Ivermectin也是有效的治療。至於malathion則需要更多的研究去評估其療效,特別是與permethrin的比較,以及其在醫療機構內及社區層面治療疥瘡的效益。

翻譯人

本摘要由三軍總醫院宋志建翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

疥瘡的介入治療,疥瘡是一種發生於全世界的寄生蟲皮膚感染,對公共衛生環境差,擁擠,社會秩序不佳等地區尤其困擾。它通常流行於資源缺乏的國家。全球盛行率預估約30億病例但是感染的程度隨著不同城市及社區而有差異。雌性蝨子鑽進皮膚產卵,孵化且繁殖。感染可以在人與人之間經由皮膚接觸而傳染,包括性接觸。它會引起皮膚極癢且破皮。不同的藥物包含草藥以及傳統醫藥已被研發治療疥瘡。本評論嘗試包含所有治療方式。作者們共找到了20個小型試驗共有2392人參與,其中17個試驗在資源缺乏國家完成,局部permethrin治療顯然對疥瘡治療最為有效,口服Ivermectin也很有效。然而Ivermectin在許多國家都沒有合法使用的執照。副作用包含紅疹,嘔吐,腹痛,但是這些試驗都規模太小以致無法適當評估罕見但可能嚴重的副作用。本文沒有包括任何中藥以及傳統治療的臨床試驗。