COMPARATIVE EFFICACY OF ORAL IVERMECTIN VERSUS SULPHUR OINTMENT (10%) IN SCABIES TREATMENT

MA SARWAR; S SALEEM

doi:10.54112/pjicm.v5i02.119

Authors

MA SARWAR Department of Dermatology, CMH Nowshera, Pakistan
S SALEEM Department of Dermatology, CMH Nowshera, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i02.119

Keywords:

Scabies, Oral Ivermectin, Sulphur Ointment, Randomized Controlled Trial, Efficacy

Abstract

Background: Scabies is a common parasitic skin infestation with significant public health impact, especially in resource-limited settings. Effective treatment is essential to reduce transmission and complications. While sulphur ointment is traditionally used, oral ivermectin has gained attention as a more convenient therapeutic option. Objective: To compare the efficacy of oral ivermectin with 10% sulphur ointment in the treatment of scabies. Study Design: Randomized controlled trial. Setting: Combined Military Hospital, Nowshera. Duration of Study: 27-November-2024 to 27-May-2025. Methods: Seventy-eight patients aged 15 to 50 years with clinically diagnosed scabies were randomly assigned to two equal groups. Group A received oral ivermectin (200 µg/kg) in two doses, one week apart. Group B applied 10% sulphur ointment topically for three consecutive nights. Patients were evaluated two weeks post-treatment. Treatment efficacy was defined as the absence of new lesions and complete healing of existing lesions, regardless of any residual nodules. Statistical analysis was conducted to compare outcomes between groups. Results: The mean age was 30.56 ± 10.40 years in the ivermectin group and 32.21 ± 11.02 years in the sulphur group. Treatment success was significantly higher in Group A (82.1%) compared to Group B (53.8%), with the difference being statistically significant (P = 0.008). Conclusion: Oral ivermectin demonstrated significantly higher efficacy than 10% sulphur ointment in treating scabies. It may be considered a more effective and patient-friendly alternative, particularly in clinical settings requiring rapid and reliable resolution of symptoms.

References

El-Moamly AA. Scabies as a part of the World Health Organization roadmap for neglected tropical diseases 2021–2030: what we know and what we need to do for global control. Trop Med Health. 2021;49(1):64. https://doi.org/10.1186/s41182-021-00348-6

Ständer S, Ständer S. Itch in scabies—what do we know? Front Med. 2021;8:628392. https://doi.org/10.3389/fmed.2021.628392

Chosidow O, Hay RJ. Control of scabies and secondary impetigo: optimising treatment effectiveness in endemic settings. Lancet Infect Dis. 2019;19(5):454–456. https://doi.org/10.1016/S1473-3099(19)30165-0

Engelman D, Steer AC. Control strategies for scabies. Trop Med Infect Dis. 2018;3(3):98. https://doi.org/10.3390/tropicalmed3030098

Karimkhani C, Colombara DV, Drucker AM, Norton SA, Hay R, et al. The global burden of scabies: a cross-sectional analysis from the Global Burden of Disease Study 2015. Lancet Infect Dis. 2015;17(12):1247–1254. https://doi.org/10.1016/S1473-3099(17)30483-8

Lobo Y, Wheller L. A narrative review of the roles of topical permethrin and oral ivermectin in the management of infantile scabies. Australas J Dermatol. 2021;62(3):267–277. https://doi.org/10.1111/ajd.13654

Prabodh W, Vikas D. A comparative study of topical permethrin, oral ivermectin, and combination of permethrin with ivermectin in patients of scabies. J Dent Med Sci. 2016;15:67–72. https://doi.org/10.9790/0853-1505016772

Meyersburg D, Welponer T, Kaiser A, Selhofer S, Tatarski R, Handisurya A, et al. Comparison of topical benzyl benzoate vs. oral ivermectin in treating scabies: a randomized study. J Eur Acad Dermatol Venereol. 2023;37(1):160–165. https://doi.org/10.1111/jdv.18573

Ertugrul G, Aktas H. Comparison of sulfur ointment and permethrin treatments in scabies. Dermatol Ther. 2022;35(12):e15897. https://doi.org/10.1111/dth.15897

Altunel CT. The efficacy, safety, and tolerability of sulfur in the treatment of scabies: a cross-sectional study. Turkiye Klinikleri J Dermatol. 2022;32(3). https://doi.org/10.5336/dermato.2022-92465

Koç HA, Açıkel SÜ. Scabies: clinical signs, diagnosis, and current treatment. Arch Curr Med Res. 2023;4(2):62–69. https://doi.org/10.47482/acmr.1244299

Al Jaff DA, Amin Hassan M. Comparison of the effectiveness of sulphur ointment, permethrin and oral ivermectin in treatment of scabies. Res J Pharm Biol Chem Sci. 2018;9(1):670–676.

Alipour H, Goldust M. The efficacy of oral ivermectin vs. sulfur 10% ointment for the treatment of scabies. Ann Parasitol. 2015;61(2):79–84.

Genuino RF, Batac MC, Capule FR, Ednalino KA, Garcia FB Jr, Ladia MA, Santos MP, Yabes AM, Cagayan MS. Comparative efficacy and safety of oral ivermectin, topical permethrin, and its combination in the treatment of scabies: a systematic literature review. J Philipp Dermatol Soc. 2022;31(1):7–19.

Mila-Kierzenkowska C, Woźniak A, Krzyżyńska-Malinowska E, Kałużna L, Wesołowski R, Poćwiardowski W, et al. Comparative efficacy of topical permethrin, crotamiton, and sulfur ointment in treatment of scabies. J Arthropod Borne Dis. 2017;11(1):1–9.

Ilyas M, Shahzad A, Siddiqui S, Awais M, Qayyum M, Azafar NA. Comparison of efficacy of oral ivermectin and topical permethrin 5% in the treatment of scabies. J Pak Assoc Dermatol. 2023;33(1):132–136. https://doi.org/10.1080/22221751.2020.1754136