J Arthropod-Borne Dis, March 2017, 11(1): 1–9 C Mila-Kierzenkowska et al.: Comparative Efficacy … 1 http://jad.tums.ac.ir Published Online: March 14, 2017 Original Article Comparative Efficacy of Topical Pertmehrin, Crotamiton and Sulfur Oint- ment in Treatment of Scabies *Celestyna Mila-Kierzenkowska 1, Alina Woźniak 1, Ewa Krzyżyńska-Malinowska 2, Lucyna Kałużna 3, Roland Wesołowski 1, Wojciech Poćwiardowski 4, Marcin Owcarz 5 1The Chair of Medical Biology, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland 2Department of Cosmetology, Torun Higher School of Business, Toruń, Poland 3Department of Cosmetology and Aesthetic Dermatology, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland 4Institute of Food Technology, Faculty of Chemical Technology and Engineering, University of Technology and Life Sciences, Bydgoszcz, Poland 5Ludwik Rydygier Voivodship Polyclinical Hospital, Toruń, Poland (Received 26 Feb 2015; accepted 13 Sep 2015) Abstract Background: Scabies is an ectoparasitic infection, which occurs because of direct skin-to skin contact. The ideal treatment modality is still unclear and further research on this topic is warranted. The aim of the study was to com- pare the efficacy and safety of the topical scabicides: permethrin, crotamiton and sulfur ointment. Methods: Fifty four patients with diagnosed scabies were randomly divided into three treatment groups. The first group received 5% permethrin cream twice with one week interval, the patients from the second group were given crotamiton lotion for two days twice with one week interval, while the third group received 10% sulfur ointment for two or three weeks. All patients were followed up at 1, 2 and 4 weeks intervals. Results: At one-week follow up the cure rate was significantly higher at permethrin-treated group when compared to crotamiton group (P< 0.001) and sulfur group (P< 0.001). At the end of two-week interval, the cure rate at perme- thrin group was 100%, while at crotamiton group, 66.7% and in sulfur group 38.9% (P< 0.001). At 4-week follow up the applied treatment was effective in all studied individuals. Conclusion: The topical application of permethrin, crotamiton and sulfur was equally efficacious at 4-week follow up, however permethrin cream showed faster improvement at first and second follow up. Acquiring permethrin is considered as expensive option and crotamiton lotion seems to be cost-less alternative to this cream. Keywords: Acaricides, Skin diseases, Parasitic infection Introduction Scabies is a contagious parasitic dermatitis that occurs among humans and other animals. The disease is caused by a tiny and usually not directly visible parasite, the mite Sarcoptes scabiei (Goldust et al. 2013a). Scabies appears worldwide and is considered significant pub- lic health problem in the developing world. There are over 300 million cases of scabies reported annually worldwide (Arif Maan et al. 2015, Thomas et al. 2015). The prevalence of scabies ranges from 2.2% in European and Middle Eastern countries to 71% in Papua New Guinea and the highest incidence of this infection is observed in the Pacific and Latin American regions as well as in aboriginal communities in northern Australia (McLean 2013, Romani et al. 2015). Scabies affects regardless age, gender, race and social class, however, risk factors include poverty, poor nutritional status, homeless, dementia and poor *Corresponding author: Prof Celestyna Mila- Kierzenkowska, E-mail: celestyna@o2.pl J Arthropod-Borne Dis, March 2017, 11(1): 1–9 C Mila-Kierzenkowska et al.: Comparative Efficacy … 2 http://jad.tums.ac.ir Published Online: March 14, 2017 hygiene (Shimose and Munoz-Prize 2013). The transmission occurs via direct skin-to-skin con- tact with an infected individual and it usually takes 15 to 20 min of close contact for suc- cessful transfer the mite to another person (Chosidow 2012). The symptoms of scabies usually emerge up to 4 weeks following initial infestation (Shimose and Munoz-Prize 2013). Human scabies is characterized clinically by pruritus with nocturnal exacerbation and scabietic nod- ules, and visible skin burrows can be the path- ognomic lesions of scabies (Hicks and Elston 2009). Classic locations of burrows are the interdigital spaces of the hand, the flexural surface of the wrist, elbows, genitalia, axil- lae, umbilicus, belt line, nipples, buttock, and penis shaft. Among pediatric population, sca- bies can also affect the head, neck, face, palm and soles (Andrews et al. 2009). There are few methods to diagnose the scabies to be sufficiently sensitive, cost ef- fective and convenient. The “gold standard” for diagnosis of human scabies with 100% specificity is the identification of mites, eggs, or feces from scrapings of infested skin or by identification of mite burrows (Walter et al. 2011). This method relies on physically lo- cating parasite on the host, so it can have low sensitivity when mites are low in num- ber. Alternate diagnosis method for scabies include polymerase chain reaction (PCR), microscopic examination of KOH prepared skin scrapings and dermoscopy, but they are still not easily applied to clinical or public health settings (Fukuyama et al. 2010, Park et al. 2012, Golant and Levitt 2012). No com- mercial immunodiagnostic tests for human scabies are currently available, and existing an- imal tests are not sufficiently sensitive (Ramp- ton et al. 2013). Treatment of scabies is a relevant issue in infectious dermatology and is as important as making correct diagnosis. Scabies is com- monly treated with various medications called acaricides, but the treatment of choice is still controversial and the search for ideal scabi- cide is ongoing. An ideal medication should be effective against adults and eggs, easily ap- plicable, non-irritating, non-toxic and econom- ical. The mainstay of treatment of scabies is topical application of scabicidal agents, like permethrin 5% cream, lindane 1% lotion or cream, benzyl benzoate 10% and 20% lotion or emulsion, crotamiton 10% cream, precipi- tated sulphur 2–10% ointment, ivermectin 0,8 % cream and others (Karthikeyan 2005). Now- adays, oral administration of ivermectin is be- ing increasingly used (Mounsey and McCarthy 2013). Despite the availability of effective ther- apeutics, treatment failures still occur, mostly secondary to application error or failure to de- contaminate fomites (Golant and Levitt 2012). The aim of the study was to compare the efficacy and safety of topical 5% permethrin cream vs. crotamiton lotion and 10% sulfur ointment in the treatment of scabies. Materials and Methods This single blind, randomized trial was conducted in patients with newly diagnosed scabies, of either gender, who were older than 18 years of age and voluntary agreed to par- ticipate in the study. Diagnosis of the disease was based on clinical symptoms and clinical history. For inclusion, the patients had to satisfy the four criteria, like the demonstra- tion of classical burrows, presence of typical scabietic lesions at the classical sites (Fig. 1), complaint of nocturnal pruritus and fam- ily history of similar illness. Exclusion crite- ria included age under 18 years, history of allergy to any of the studied drugs, pregnan- cy or lactation, women planning for concep- tion in near future as well as history of se- vere systemic disorders, like cardiac disor- ders, nervous system disorders, psychiatric illness and immunosuppressive disorders. Par- ticipants with abnormal kidney and liver func- tion and known chronic infectious diseases were also excluded. J Arthropod-Borne Dis, March 2017, 11(1): 1–9 C Mila-Kierzenkowska et al.: Comparative Efficacy … 3 http://jad.tums.ac.ir Published Online: March 14, 2017 Before entry to the study, patients were given a physical examination and their his- tory of infestations; antibiotic treatment and other information were recorded. Partici- pants with any other coexisting skin disease, which could interfere with subsequent mon- itoring of scabies and patients with atypical presentations, as crusted scabies were ex- cluded from the trial. None of the patients participating in the trial had been treated with pediculicides, scabicides or other topi- cal agents in the month preceding the trial. The studied group consisted of total 54 patients (22 males and 32 females) from 19 to 83 years of age. The patients were allo- cated to any of three treatment groups with simple randomization. All participants re- ceived detailed information about proper administration of the used drug. The patients included into the first group (8 men and 10 women) received single application of 5% permethrin cream at Day 1 and they were asked to put a thin layer of cream to all areas of the body including the face and the scalp. The cream was washed off after 8 hours and the single application was repeated 1 week later if live mites were seen during one-week follow up. The second group (7 men and 11 women) was given topical crotamiton lotion and they were told to apply the drug to the entire skin surface, rinse off after 24 hours and then reapply for an additional 24 hours. The procedure was repeated at all individuals twice, with one-week interval. When there was no cure in two weeks, 2nd treatment was giv- en with 10% sulfur ointment. The third group (7 men and 11 women) received 10% sulfur ointment for the period of two or three weeks (if there were no cure at 2-week follow up). Ten percent precipitate sulfur in petroleum base was used and as other topical drugs, it was thoroughly rubbed into the skin over the whole body covering neck to toe. The pa- tients were asked to wash off the ointment after 24 hours and then reapply the drug eve- ry 24 hours for two (or three) weeks with a bath taken between each application. The treatment was given to both patients and their close family members, even without symp- toms, at the same time. The participants of the study were also asked not to use any an- tipruritic drug or any other topical medications. On entry of the study baseline, clinical pa- rameters were comparable and the number of patients in each treatment group who were graded as having mild, moderate or severe infestation was not statistically different. The clinical evaluation after treatment was made by experienced investigator who was blinded to the treatments received. Patients in all the three groups were followed up at intervals of 1, 2 and 4 weeks to assess compliance and to examine clinically the patients to evaluate efficacy and safety. At each assessment, the investigator recorded the count of the lesions and grading of pruritus both subjectively and objectively by the patients as described on the first visit. Any adverse events were also recorded. The patient was considered as “cured” in case of the absence of new le- sions, clinical improvement in the skin lesions and the improvement in the pruritus assessed by the visual analogue scale. “Re-infestation” was defined as a cure at 2 weeks but de- velopment of new lesions at 1-month follow- up. Treatment would be considered as failure if at the end of 4 weeks there was no im- provement in the skin lesions and pruritus. The study was approved by the appropri- ate Bioethics Committee (number KB 135/ 2014) and written informed consent was ob- tained from all the patients. The percentage of improvement was com- pared between groups using the χ2 test fol- lowed by post-hoc Tukey’s test and P< 0.05 was considered significant. SPSS software (IBM SPSS Statistics 21) (Chicago, IL, USA) was used for all the analysis. Results At one-week follow up in permethrin treated J Arthropod-Borne Dis, March 2017, 11(1): 1–9 C Mila-Kierzenkowska et al.: Comparative Efficacy … 4 http://jad.tums.ac.ir Published Online: March 14, 2017 group the treatment was effective in 11 of 18 patients (61.1%) and in none of patients in crotamiton and sulfur group (Fig. 2). Thus, at first follow up the cure rate was signifi- cantly higher after the single application of 5% permethrin cream when compared to the use of crotamiton lotion (P< 0.001) and 10% sulfur ointment (P< 0.001). At the end of two- week interval, the cure rate at permethrin group increased to 100% (after repeating ap- plication at remained 7 patients who had in- festations at one-week follow up) and after two weeks of treatment none of patients in- cluded to this group still had severe itching and skin lesions. In crotamiton group, at the second follow-up, the cure rate was 66.7% (12 of 18 patients) compared with cure rate of 38.9% (7 of 18 patients) in the sulfur oint- ment group (P< 0.001). After two weeks of treatment the remaining 17 patients (6 in crotamiton group and 11 in sulfur group), who still manifested with scabietic lesions were treated with 10% sulfur ointment for the next week and the infestation was cured at all of them after three weeks of treatment (Fig. 2). Hence, at 4-week follow up the applied treat- ment was effective in all studied individuals. All treatment modalities studied in this paper were considered cosmetically accepta- ble and well tolerated by all patients. None of participants experienced allergic reactions and no major adverse events were observed in any of the 3 groups. The main adverse event was skin dryness, reported by patients treat- ed with sulphur ointment longer that two weeks, but it was not serious and did not affect compliance. None of the patients ex- perienced worsening of infestation during the study, but at two patients treated with sulfur ointment re-infestation occurred at one-month follow-up. Fig. 1. Characteristic skin lesions in adult with clas- sic scabies 0 10 20 30 40 50 60 70 80 90 100 after 7 days of treatment after 14 days of treatment after one month of treatment % o f c ur ed p at ie nt s permethrin crotamiton sulphur Fig. 2. The cure rate at studied patients with scabies treated with 5% permethrin cream, crotamiton lotion and 10% sulphur ointment J Arthropod-Borne Dis, March 2017, 11(1): 1–9 C Mila-Kierzenkowska et al.: Comparative Efficacy … 5 http://jad.tums.ac.ir Published Online: March 14, 2017 Discussion Our study compared the use of 5% per- methrin cream with that of crotamiton lotion and 10% sulfur ointment. The obtained re- sults demonstrate that 5% permethrin cream is the most effective drug at 1 week follow up in treating scabies, what is in accordance with previous studies that have reported ex- cellent cure rates with permethrin. In our study single application of permethrin resulted in improvement at 61.1% of patients, while in a study carried by Usha and Gopalakrishnan (2000) even a higher number of patients (97.8%) showed clearance of lesions at one- week follow up as compared to our results. Bachewar et al. (2009) found that at one week follow up, permethrin had significantly better cure rate than ivermectin, but at the end of two-weeks treatment this finding was reversed. Taplin et al. (1990) in a double-blind- ed, randomized study compared crotamiton 10% cream and permethrin 5% cream for the treatment of scabies in children 2 months to 5 years of age. Two weeks after a single over- night treatment, 30% children were cured with permethrin, in contrast to only 13% of sub- jects treated with crotamiton. Four weeks af- ter treatment the efficacy in favor of perme- thrin was still statistically significant and this agent also demonstrated greater effective- ness in reducing pruritus and secondary bac- terial infections. A single overnight topical application of 5% permethrin cream is su- perior to a single dose of oral ivermectin (Usha and Gopalakrishnan 2000). Permethrin being both miticidal and ovicidal appears to be more effective than for example crotamiton, which though is effective for adult stages of the mite, is not known to kill eggs and larvae. Thus, single application of crotamiton may be not accurate to eradicate the parasite and a second dose is needed within 1 to 2 weeks for 100% cure. The study of Pourhasan et al. (2013) demon- strated, in turn, that in the treatment of scabies 5% permethrin cream was as effective as 10% crotamiton cream at two week follow-up. In our study at the second follow-up the cure rate for permethrin group was 100% and in crotamiton group 66.7%, while after 4 weeks, considered the definitive point for evaluating the efficacy of applied treatments, 5% per- methrin cream was found to be as effective as crotamiton lotion and 10% sulfur oint- ment in treating scabies. This is in accord- ance with few reports about the comparable efficacy of treatment with permethrin cream and other scabicides, like topical 1% iver- mectin (Goldust et al. 2013b), topical Tenutex emulsion (containing among others disulfi- ram and benzyl benzoate) (Goldust et al. 2013c) as well as oral ivermectin (Ranjkesh et al. 2013). Sharma and Singal (Sharma and Singal 2011) in randomized double-blind con- trolled study evaluated the efficacy and safe- ty of topical 5% permethrin and oral iver- mectin in single and two dose regimens in treatment of scabies. Their study revealed that all three-treatment modalities had the equal efficacy at the end of 4 weeks of treat- ment. Moreover, Chhaiya et al. (2012) report- ed that topical ivermectin as 1% lotion is as effective as 5% permethrin, but significantly more effective than oral ivermectin. On the other hand, Abedin et al. (2007) found that mass treatment of scabies with 2 doses of oral ivermectin in an endemic pediatric pop- ulation is more efficacious than single topi- cal application of 5% permethrin. Oral iver- mectin produced also significantly better cure rate than lindane 1% lotion at 4 weeks fol- low-up (Mohhebipour et al. 2013). The au- thors suggest that oral ivermectin can be alternative treatment at patients with scabies, for whom topical therapies can cause serious cutaneous and systemic problems. Ivermec- tin is generally considered as effective as permethrin and more effective than other med- ications, such as lindane, benzyl benzoate, J Arthropod-Borne Dis, March 2017, 11(1): 1–9 C Mila-Kierzenkowska et al.: Comparative Efficacy … 6 http://jad.tums.ac.ir Published Online: March 14, 2017 crotamiton and malathion (Panahi et. 2015). Moreover, Miyajima et al. (2015) described a novel method for scabies treatment called “whole-body bathing method”. In this meth- od, the patients would bathe themselves in a fluid containing ivermectin at an effective concentration. The selection of a drug is often based on the personal preference of physician, local availability and cost for the patient, rather than on medical evidence (Wolf and Da- vidovici 2011). In the present study, a 100% cure rate was obtained at all three studied groups after one month of treatment what suggest that all applied modalities were equal- ly efficacious. However, permethrin cream has more rapid onset of action as at the first follow up, the patients from permethrin group reported better improvement than the pa- tients included to the crotamiton and sulfur ointment group. Permethrin is a first-line ac- aricide in many countries due its high effec- tiveness against mites and low mammalian toxicity. One treatment with permethrin cream is usually effective in eradicating scabies, but some experts recommend retreatment one week later (Strong and Johnstone 2007). The significant limitation in the use of perme- thrin in treatment of scabies is its cost, as it is the most expensive drug of all topical sca- bicides (Roos et al. 2001). Crotamiton (cro- tonyl-N-ethyl-o-toluidine) as 10% lotion or cream is approved for use in adults with sca- bies (Pourhasan et al. 2011). The best results seem to be obtained when the drug is applied twice daily for five consecutive days after bathing and changing clothes. Goldust et al. (2014) demonstrated that such application of crotamiton was as effective as single dose of invermectin at two-week follow up. However, some authors do not recommend crotamiton because of the lack of efficacy and toxicity data (Meinking 1999). Sulfur, used as an ointment (2%-10%), is the oldest scabicide in use (Karthikeyan 2005). Topical sulphur ointment is messy, malodourous, stains cloth- ing, and in hot and humid climate, it may lead to irritant dermatitis (Taplin and Mein- king 1988). However, it has the advantage of being very cheap and may be the only alter- native at patients whose financial state dic- tates the choice of this antiscabietic drug due to its low cost. Moreover, it is recommended as a safe agent in a treatment of infants, chil- dren and pregnant women (Chosidow 2012). Sharquie et al. (2012) evaluated the therapeu- tic regimen of 8% and 10% topical precipi- tated sulfur in petrolatum ointment for single day, three successive nights or three succes- sive days at total 97 patients with scabies and they revealed that single-day application was much less effective than three-days treat- ment. In the group of participants treated for single day, only 42.4% participants respond- ed to management, while in group who re- ceived sulfur ointment for three successive nights the response was observed in 90.6% and in those who received the treatment for three successive days it was 96.9% of pa- tients. However, at patients who received only single dose of sulfur ointment fewer side effects were observed. In our study, 10% sulfur ointment was effective at 6 of 18 pa- tients after two-weeks treatment and in re- mained 11 of patients after three weeks of daily application. Although this drug is well tolerated in most of the patients the major problem of the topical scabicides, life sulfur ointment, is the requirement for repeated ap- plication because of their relative low effi- cacy. On the other hand, the cost is still the lowest. Our study also evaluated the safety of ap- plication of various topical agents in treat- ment of scabies. Oberoi et al. (2007) investi- gated the effect of topical application of 1% lindane lotion and 5% permethrin cream on oxidant-antioxidant balance in blood of pa- tients with scabies and they found that per- methrin, in contrary to lindane, showed no significant alteration in oxidative stress mark- ers. The medication applied at studied pa- J Arthropod-Borne Dis, March 2017, 11(1): 1–9 C Mila-Kierzenkowska et al.: Comparative Efficacy … 7 http://jad.tums.ac.ir Published Online: March 14, 2017 tients of all three groups were well-tolerated by most of the patients and no serious ad- verse effects were observed in the course of treatment suggesting that all studied agents are safe and non-toxic. Conclusions The topical application of 5% permethrin cream, crotamiton lotion and 10% sulfur oint- ment was equally efficacious at one-month follow up. Nevertheless, complete clearance of scabietic lesions occured earlier in pertmehrin- treated group than in crotamiton and sulfur groups. No side effects and no re-infections were observed both after administration of permethrin and crotamiton. Although perme- thrin seems to be the most effective drug in the treatment of scabies, its administration is much more expensive for patients that other common creams. Thus, we conclude that crotamiton may be a cost-effective alterna- tive to permethrin with acceptable cure rate in the treatment of Sarcoptes scabiei infection. Acknowledgements We thank to all the volunteers who par- ticipated in the study and we declare no fi- nancial support for the project. The authors declare that there is no conflict of interests. References Abedin S, Narang M, Gandhi V, Narang S (2007) Efficacy of permethrin cream and oral ivermectin in treatment of scabies. Indian J Pediatr. 74(10): 915– 916. Andrews RM, McCarthy J, Carapetis JR, Currie DJ (2009) Skin disorders, in- cluding pyoderma, scabies, and tinea infections. Pediatr Clin N Am. 56: 1421–1440. Arif Maan MA, Arif Maan MS, Sohail AM, Afif M (2015) Bullous scabies: a case report and review of the literature. BMC Res Notes. 8: 254–257. Bachewar NT, Thawani VR, Mali SN, Gharpure KJ, Shingade VP, Dakhale GN (2009) Comparison of safety, effi- cacy, and cost effectiveness of benzyl benzoate, permethrin, and ivermectin in patients with scabies. Indian J Phar- macol. 41: 9–14. Chhaiya SB, Patel VJ, Dave JN, Mehta DS, Shah HA (2012) Comparative efficacy and safety of topical permethrin, topi- cal ivermectin, and oral ivermectin in patients of uncomplicated scabies. In- dian J Dermatol Venerol Leprol. 78: 605–610. Chosidow O (2012) Clinical practices. Scabies. N Engl J Med. 354(16): 1718–1727. Fukuyama S, Nishimura T, Yotsumoto H, Gushi A, Tsuji M, Kanekura T, Ma- tsuyama T (2010) Diagnosis usefulness of a nested polymerase chain reaction assay for detecting Sarcoptes scabiei DNA in skin scrapings from clinically suspected scabies. Br J Dermatol. 163: 875–899. Golant AK, Levitt JO (2012) Scabies: a re- view of diagnosis and management based on mite biology. Pediatr Rev. 33(1): e1–e12. Goldust M, Rezaee E, Raghifar R, Naghavi- Behzad M (2013a) Ivermectin vs. lin- dane in the treatment of scabies. Ann Parasitol. 59(1): 37–41. Goldust M, Rezaee E, Raghifar R, Hemayat S (2013b) Treatment of scabies: the topical ivermectin vs. permethrin 2.5% cream. Ann Parasitol. 59(2): 79–84. Goldust M, Rezaee E, Raghifar R, Naghavi- Behzad M (2013c) Comparison of per- methrin 2.5% cream vs. Teutex emul- sion for the treatment of scabies. Ann Parasitol. 59(1): 31–35. Goldust M, Rezaee E, Raghifar R (2014) Comparison of oral ivermectin versus J Arthropod-Borne Dis, March 2017, 11(1): 1–9 C Mila-Kierzenkowska et al.: Comparative Efficacy … 8 http://jad.tums.ac.ir Published Online: March 14, 2017 crotamiton 10% cream in the treatment of scabies. Cutan Ocul Toxicol. 33(4): 333–336. Karthikeyan K (2005) Treatment of scabies: newer perspectives. Postgrad Med J. 81: 7–11. McLean FE (2013) The elimination of sca- bies: a task for our generation. Int J Dermatol. 52: 1215–1223. Meinking TL (1999) Infestations. Curr Probl Dermatol. 11: 80–103. Miyajima A, Komoda M, Akagi K, Yuzawa K, Yoshimasu T, Yamamoto Y, Hirota T (2015) Experimental study of phar- macokinetics of external, whole-body bathing application of ivermectin. J Dermatol. 42: 87–89. Mohebbipour A, Saleh P, Goldust M, Amir- nia M, Zadeh YJ, Mohamad RM, Re- zaee E (2013) Comparision of oral ivermectin vs. lindane lotion 1% for the treatment of scabies. Clin Exp Dermatol. 38: 719–723. Mounsey KE, McCarthy JS (2013) Treat- ment and control of scabies. Curr Opin Infect Dis. 26: 133–139. Oberoi S, Ahmed RS, Suke SG, Bhattachar- ya SN, Chakraborti A, Banerjee BD (2007) Comparative effect of topical application of lindane and permethrin on oxidative stress parameters in adult scabies patients. Clin Biochem. 40: 1321–1324. Park JH, Kim CW, Kim SS (2012) The di- agnostic accuracy of dermoscopy for scabies. Ann Dermatol. 24(2): 194–199. Panahi Y, Poursaleh Z, Goldust M (2015) The efficacy of topical and oral iver- mectin in the treatment of human sca- bies. Ann Parasitol. 61(1): 11–16. Pourhasan A, Goldust M, Rezaee E (2013) Treatment of scabies, permethrin 5% vs. crotamiton 10% cream. Ann Para- sitol. 59(3): 143–147. Rampton M, Walton SF, Holt DC, Pasay C, Kelly A, Currie BL, McCarthy JS, Mounsey KE (2013) Antibody respons- es to Sarcoptes scabiei apolipoprotein in a porcine model: relevance to immunodiagnosis of recent in- fection. PLOS One 8(6): e65354. Ranjkesh MR, Naghili B, Goldust M, Rezaee E (2013) The efficacy of permethrin 5% vs. oral ivermectin for the treat- ment of scabies. Ann Parasitol. 59(4): 189–194. Romani L, Steer AC, Whitfeld MJ, Kaldor JM (2015) Prevelence of scabies and im- petigo worldwide: a systematic review. Lancet Infect Dis. 15(8): 960–967. Roos TC, Alam M, Roos S, Merk HF, Bick- ers DR (2001) Pharmacotherapy of ec- toparasitic infections. Drugs. 61: 1067– 1088. Sharma R, Singal A (2011) Topical perme- thrin and oral ivermectin in the man- agement of scabies: a prospective, ran- domized, double blind, controlled study. Indian J Dermatol Venerol Leprol. 77: 581–586. Sharquie KE, Al-Rawi JR, Noaimi AA, Al- Hassany HM (2012) Treatment of sca- bies using 8% and 10% topical sulfur ointment in different regimens of ap- plication. J Drugs Dermatol. 11(3): 357– 364. Shimose L, Munoz-Prize S (2013) Diagno- sis, prevention, and treatment of sca- bies. Curr Infect Dis Rep. 15: 426–431. Strong M, Johnstone P (2007) Interventions for treating scabies. Cochrane Database Syst Rev. 3: CD000320. Taplin D, Meinking TL (1988) Infestations. In: Schechner LA, Hansen RC (Eds): Pe- diatric dermatology. Vol. 2. Churchill Livingstone, New York, pp. 1465–1516. Taplin D, Meinking TL, Chen JA, Sanchez R (1990) Comparison of crotamiton 10% cream (Eurax) and permethrin 5% cream (Elimite) for treatment of sca- bies in children. Pediatr Dermatol. 7 (1): 67–73. J Arthropod-Borne Dis, March 2017, 11(1): 1–9 C Mila-Kierzenkowska et al.: Comparative Efficacy … 9 http://jad.tums.ac.ir Published Online: March 14, 2017 Thomas J, Pterson GM, Walton SF, Carson CF, Naunton M, Baby KE (2015) Sca- bies: an ancient global disease with a need for new therapies. BMC Infect Dis. 15: 250–255. Usha V, Gopalakrishnan Nair TV (2000) A comparative study of oral ivermectin and topical permethrin cream in treat- ment of scabies. J Am Acad Dermatol. 42(2): 236–240. Walter B, Heukelbach J, Fengler G, Worth C, Hengge U, Feldmeier H (2011) Com- parison of dermoscopy, skin scraping and the adhesive tape test for the diag- nosis of scabies in a resource poor set- tings. Arch Dermatol. 147: 468–473. Wolf R, Davidovici B (2011) Treatment of scabies and pediculosis: facts and con- troversies. Clin Dematol. 28: 511–518.