Clinical Evidence Handbook

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Am Fam Physician. 2015 Nov 15;92(10):919-920.

Author disclosure: Paul Johnstone and Mark Strong declare they have no competing interests.

Scabies is an infestation of the skin by the mite Sarcoptes scabiei. In adults, the most common sites of infestation are the fingers and the wrists, although it may manifest in older persons as a diffuse truncal eruption.

  • Scabies is a very common public health problem. In many resource-poor settings, it is an endemic problem; whereas in industrialized countries, it is most common in institutionalized communities.

  • Topical permethrin seems highly effective at increasing clinical cure of scabies within 28 days.

Topical permethrin use has been associated with isolated reports of serious adverse effects, including death.

Topical crotamiton seems effective at increasing clinical cure of scabies at 28 days, although it is less effective than topical permethrin.

We found insufficient evidence to judge the effectiveness of topical benzyl benzoate, topical malathion, or topical sulfur compounds for treating scabies.

Oral ivermectin seems more effective at increasing clinical cure of scabies compared with placebo. It may be more effective at increasing clinical cure compared with topical benzyl benzoate. However, it may be less effective than topical permethrin in the short term.

  • There have been isolated reports of severe adverse effects with oral ivermectin, including death and convulsion, but these are rare.

  • Observational data suggest that oral ivermectin may be effective in certain circumstances, such as when included in the treatment of hyperkeratotic crusted scabies, in persons with concomitant human immunodeficiency virus (HIV) infection, and when treating outbreaks in residential facilities.

  • Although tested in randomized controlled trials (RCTs), oral ivermectin is not presently licensed for the treatment of scabies in most countries. It is only available on a named patient basis in the United Kingdom.

Topical lindane use has been restricted or is not available in many parts of the world owing to the mounting evidence for serious adverse effects. We have not included it in this review. However, it may be the most effective treatment that is locally available in some countries. Harms must be carefully weighed against benefits before it is used.

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Clinical Questions

What are the effects of topical treatments for

Author disclosure: Paul Johnstone and Mark Strong declare they have no competing interests.

Adapted with permission from Johnstone P, Strong M. Scabies. Clin Evid Handbook. June 2015:582–583. Visit for full text and references.

This is one in a series of chapters excerpted from the Clinical Evidence Handbook, published by the BMJ Publishing Group, London, U.K. The medical information contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of the Clinical Evidence Handbook, as well as online at (subscription required).

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.

A collection of Clinical Evidence Handbook published in AFP is available at


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