Page 146 - LECTURE NOTES

the skin and expose the patient to secondary infection. Always advice the patient to

bath before treatment for general hygienic reasons. However, in epidemics of scabies
all cases should be treated at the same time and it is important to boil and iron used

clothings in order to prevent reinfection.

A 20-25% benzyl benzoate emulsion can be painted on a patient from the neck
downwards. After allowing some 5-10 minutes for this application to dry the patient can

re-dress in clean clothes. The patient should not bathe for 48 hours. The treatment
should be used for 3 consecutive days. Only in rare cases does dermatitis result from

the use of benzyl benzoate and this is more likely to happen in young children.

Mitigal is a yellowish oily liquid sulphur preparation, which is painted undiluted over the

body from the neck downward for one week. A single treatment should be 100%
effective. A mild form of dermatitis may be produced in some people. Tetmosol is

another sulphur compound sometimes used to treat scabies. It is slow in its action and
usually about three treatments 24 hours apart are recommended for a complete cure. It

is therefore of limited use in mass community treatments. It has been combined with
soap and sold as temosol soap, and in this from, when regularly used in washing and

bathing, it has a slow curative effect and also acts as a prophylactic.

Although these two sulphur preparations and benzyl benzoate are still used, a better

treatment for scabies consists of applying a 1% gama bezene haxachloride cream or

lotion, 1% Malathion aqueous emulsion or 5% permethrin cream (Elimite). Permethrin
actually should be used very carefully especially when applied to infants and small

children. A single treatment has a high success rate. A second application 2-7 days
later, if this proves possible, ensures a complete cure. Crotaimition (Eurax) applied as a

10% cream or lotion is a very safe treatment but weak scabiecide. However, two times
daily applications are needed. More recently it has been shown that ivermectin given,

as a single oral dose of 100-200 μg/kg body weight is effective in killing scabies mites.

140