Comparative Efficacy and Safety of Permethrin and Ivermectin in the Treatment of Scabies

Background: Scabies, a highly contagious parasitic skin infestation caused by Sarcoptes scabiei, remains a significant public health concern in Bangladesh, particularly in densely populated areas with poor sanitation and limited access to healthcare. Conventional treatments like topical permethrin and oral ivermectin have proven effective, but refractory cases pose challenges due to increasing resistance to monotherapy. Objective: This study aims to evaluate the efficacy of combined therapy using ivermectin and permethrin in treating refractory scabies cases in Bangladesh. Methodology: A total of 100 patients diagnosed with scabies were enrolled at the out-patient department of Dermatology and Venereology at Jalalabad Ragib Rabeya Medical College and Hospital, Sylhet from June 2023 to July 2024. Patients were randomly assigned to receive either topical permethrin (Group B) or oral ivermectin (Group A). Informed written consent was obtained, and exclusion criteria included pregnant women, those with severe systemic diseases, or known hypersensitivity to the drugs. The study assessed outcomes at baseline, the 7th day, and the 14th day. Results: Analysis revealed that permethrin was significantly more effective than ivermectin in reducing clinical scores over the two-week period. At baseline, Group A had a mean score of 8.20 ± 2.21, which decreased to 2.60 ± 2.35 by day 14, while Group B showed a mean score reduction from 7.58 ± 2.01 to 0.37 ± 1.10. Adverse effects varied, with ivermectin causing mild systemic symptoms (nausea, headache) and permethrin leading to localized skin irritation (pruritus, burning sensation). Conclusion: Both ivermectin and permethrin are effective in treating scabies, but permethrin demonstrates superior efficacy in clinical outcomes. These findings highlight the importance of tailored treatment approaches for refractory scabies, considering individual patient profiles and monitoring for adverse effects to enhance patient adherence and optimize outcomes.