Letter
Optimal treatment for scabies remains undetermined

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To the Editor:

A recent publication by Usha and Nair presented clinical data suggesting that topical permethrin cream was slightly superior to oral ivermectin in the treatment of scabies (J Am Acad Dermatol 2000;42:236-40). We do not dispute their results, but inasmuch as many have experienced the reverse in clinical practice, we offer a few comments.

First, although initially many observers found that one dose of ivermectin at 200 μg/kg was curative,1 many have altered their dosing pattern.2 Indeed, there is

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    Citation Excerpt :

    In contrast, 5% permethrin has been standard treatment for scabies for more than 20 years, with little or no apparent evidence of clinical resistance.14 Although no cases of scabies resistant to permethrin have been documented, several controlled studies have revealed diminished sensitivity to this insecticide.15 An in vitro acaricide efficacy study suggested that scabies mites are becoming increasingly tolerant to permethrin16: 35% of mites exposed to 5% permethrin were still alive after 18 to 22 hours.

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