![]() ![]() The best treatment option for a particular patient must consider local resistance. A recent trial found that treatment of pediculosis capitis with dimethicone was associated with significantly higher cure rates than treatment with 1% permethrin lotion. However, permethrin has been associated with widespread resistance, and newer options that physically target lice, such as dimethicone, have been studied. A systematic review of trials that evaluated medications for the treatment of pediculosis capitis suggested that permethrin was efficacious. Ī common first-line treatment option for pediculosis capitis is 1% permethrin lotion, which is available over the counter in many countries. Some patients may continue to experience pruritus for four weeks after proper treatment. Items can also be sealed within a bag for a minimum of two to three days as an alternative. Maintaining personal hygiene and washing items, such as clothes and bedsheets, is essential at high temperatures. Also, clinicians should treat close contacts and sexual partners during the prior two months. In endemic regions and during a scabies epidemic, the large patient population can more easily receive treatment with 200 micrograms/kilogram of oral ivermectin than with topical medications. Patients may benefit from combined treatment with a topical medication, such as 5% permethrin cream and 200 micrograms/kilogram of oral ivermectin to treat crusted scabies. However, the best treatment for crusted scabies remains undetermined due to insufficient research in this area. In the United States, 5% topical permethrin cream is a first-line treatment option for scabies. Ĭlassical scabies can have treatment with 5% permethrin cream, 200 micrograms/kilogram of oral ivermectin, or 10% to 25% benzyl benzoate lotion per European guidelines. The treatment of choice for a particular patient should be guided by several factors, including efficacy, safety profile, and the ability to administer the medication properly. The risk of adverse events was lowest with synergized pyrethrins, but permethrin scored better than several treatments, such as lindane and topical ivermectin. This analysis also found that permethrin was less often associated with persistent itching than other included treatments, like crotamiton and lindane, but was outperformed by topical ivermectin in this category. Ī recent network meta-analysis evaluating randomized controlled trials found that treatment with combined permethrin and oral ivermectin for scabies was associated with the highest cure rate however, combination treatment was not significantly better than permethrin alone only one randomized controlled trial included this combination treatment. There was moderate-certainty evidence to conclude that the proportion of patients with one or more drug-related adverse events was similar to those treated with permethrin cream or oral ivermectin. However, clearance may be inferior after the first week when using oral ivermectin. A review of clinical trials resulted in low-certainty evidence demonstrating that after two weeks of administration, 5% permethrin cream and 200 micrograms/kilogram of oral ivermectin demonstrated similar efficacy for the treatment of scabies. Several studies have assessed the effectiveness and safety of permethrin when compared with other treatments for scabies. Ī patient with classic scabies often presents with generalized pruritus that is exacerbated overnight with inflammatory papules primarily localized to the area between the fingers, flexural sites, genitalia, breasts, and buttocks with or without burrows. The clinical diagnosis of pediculosis capitis relies upon the detection of living lice. The United States Food and Drug Administration (FDA) has approved the use of permethrin, a synthetic pyrethroid, to treat scabies and pediculosis capitis. ![]()
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