Buffet M, Dupin N
Service de Dermato-Vénéréologie, Groupe Hospitalier Cochin, Pavillon Tarnier - Hôpital Cochin, 89, rue d'Assas, 75006 Paris, France.
Fundam Clin Pharmacol. 2003 Apr;17(2):217-25. doi: 10.1046/j.1472-8206.2003.00173.x.
Scabies is a frequent interhuman ectoparasitic infection. Several treatments are available worldwide. There are local treatments: synthetic pyrethrins, benzyl benzoate, lindane, crotamiton. Recently a few studies were published concerning ivermectin, systemic antiparasitic agent use in onchocercosis treatment. We reviewed the literature with an evidence-based medicine method. We attempt to answer two questions in particular: what is the treatment of choice for common scabies in a patient otherwise in good health? What is the role of systemic ivermectin? We also report specific situations. Among local treatments, studies are heterogeneous according to products, countries, group of treated patients, with or without contact subjects, and the method of treatment application. There are very few high proof-level controlled studies. In France, a combination of benzyl benzoate 10% and sulfiram 2% is used most, according to professional consensus. The most studied product is the cream permethrin 5%, available in the USA and UK. Its efficacy seems slightly superior to lindane and less toxic. It is more efficient than crotamiton. There is no study comparing benzyl benzoate and permethrin. Concerning systemic ivermectin, five controlled studies showed its efficiency in common scabies. But its relative efficiency over local treatment has not been established. A few open studies showed its efficacy in institutional epidemic, profuse scabies and in HIV-positive patients. Local treatment of choice in common scabies remains to be determined among the four principal molecules. There is no study comparing permethrin or esdepallethrin to benzyl benzoate. In what cases should we prescribe crotamiton or lindane? Indication of ivermectin seems proved in common scabies and probably for HIV-positive patients. It remains to be determined if it should be prescribed in the first instance, be double or triple, be associated or not with local treatment. In case of keratotic scabies, ivermectin seems interesting with two applications within 1 week, and should be associated with local treatment (duration remains to be defined). Ivermectin is probably useful in institutional epidemic, and therapeutic attitude remains to be defined. Ivermectin seems to have little or no risk. Treatment must be adapted case-by-case, according to feasibility. It is still important to treat contacts, and modality of this treatment remains to be specified.
疥疮是一种常见的人际间体表寄生虫感染。全球有多种治疗方法。有局部治疗药物：合成除虫菊酯、苯甲酸苄酯、林丹、克罗米通。最近有一些关于伊维菌素的研究发表，伊维菌素是一种用于治疗盘尾丝虫病的全身性抗寄生虫药物。我们采用循证医学方法对文献进行了综述。我们特别试图回答两个问题：对于身体健康的普通疥疮患者，首选治疗方法是什么？全身性伊维菌素的作用是什么？我们还报告了一些特殊情况。在局部治疗药物中，根据产品、国家、治疗患者群体、有无接触者以及治疗应用方法的不同，研究结果存在差异。高质量对照研究非常少。在法国，根据专业共识，最常使用的是10%苯甲酸苄酯和2%磺胺醋酰的组合。研究最多的产品是5%氯菊酯乳膏，在美国和英国有售。其疗效似乎略优于林丹且毒性较小。它比克罗米通更有效。没有研究比较苯甲酸苄酯和氯菊酯。关于全身性伊维菌素，五项对照研究表明其对普通疥疮有效。但其相对于局部治疗的相对疗效尚未确定。一些开放性研究表明其在机构性流行、严重疥疮和HIV阳性患者中有效。普通疥疮的局部首选治疗方法仍有待在这四种主要药物中确定。没有研究比较氯菊酯或炔丙菊酯与苯甲酸苄酯。在哪些情况下我们应该开克罗米通或林丹？伊维菌素在普通疥疮以及可能在HIV阳性患者中的应用指征似乎已得到证实。是否应首先开具伊维菌素、剂量应为双倍还是三倍、是否应与局部治疗联合使用仍有待确定。在角化性疥疮的情况下，伊维菌素在1周内分两次应用似乎有效，并且应与局部治疗联合使用（持续时间仍有待确定）。伊维菌素在机构性流行中可能有用，治疗方案仍有待确定。伊维菌素似乎几乎没有风险。治疗必须根据可行性逐案调整。治疗接触者仍然很重要，这种治疗的方式仍有待明确。
