Topical Permethrin Research Articles

Management of common scabies and postscabetic itch in adults: Lessons learned from a single-center retrospective cohort study.

Common scabies can be difficult to diagnose and treat. There are limited data on the clinical characteristics of patients who may benefit from combined topical permethrin plus oral ivermectin. Postscabetic itch is common, but there is scant data describing its prognosis and management. This study describes the clinical characteristics and evaluates treatment outcomes of participants with common scabies treated with combined topical permethrin plus oral ivermectin and describes the prognosis and management of postscabetic itch. We conducted a single-center retrospective cohort study of participants with common scabies treated with combined topical permethrin plus oral ivermectin therapy and topical permethrin only. Participants previously treated with permethrin and/or ivermectin were excluded. The primary outcome was clinical outcome at follow-up, categorized as cure, worsening, or no change. Secondary outcomes included time from treatment initiation to cure, duration of follow-up after cure, recurrence rate, frequency of postscabetic itch, and duration of postscabetic itch. Of 55 participants treated with combined topical permethrin plus oral ivermectin, 49 (89%) achieved cure, 5 (9%) had no change, and 1 (2%) had worsening disease. Of 48 participants treated with topical permethrin only, 46 (96%) achieved cure, 2 (4%) had no change, and 0 (0%) had worsening disease. Thirty-five participants (34%) experienced postscabetic itch for 52.5 days (interquartile range, 28-135). More participants in the older (mean: 55 years; standard deviation: 21 years; p = .002) combined treatment group experienced postscabetic itch than in the younger (mean: 42 years; standard deviation: 19 years) permethrin-only treatment group (42% vs. 25%; p = .072). These findings support the use of combined topical permethrin plus oral ivermectin therapy in treating common scabies, highlight that postscabetic itch can persist for longer than previously reported, and reveal a potential relationship between older age and postscabetic itch.

A narrative review of the roles of topical permethrin and oral ivermectin in the management of infantile scabies.

As standard treatments are not licensed for use in the infantile population, the treatment of scabies in this age group can be challenging. We review the relevant evidence to determine the roles of topical permethrin and oral ivermectin in the management of infantile scabies. Demographic and clinical data were collected from relevant English articles published from January 2000 to December 2020. Complete resolution was observed in 100% of infants younger than two months treated with permethrin, and 87.6% of infants aged 12months or less and/or children weighing under 15kg treated with ivermectin. Adverse effects from permethrin use were limited to local eczematous reactions. Adverse effects from ivermectin use included mildly elevated creatine kinase levels, eczema flare-ups, diarrhoea, vomiting, irritability, pruritus and pustular skin reactions. Overall, both permethrin and ivermectin appear to have an acceptable safety profile in infants. Permethrin is highly effective as a first-line therapy for scabies in infants younger than two months. Ivermectin use is recommended when authorised topical treatment has failed, in crusted scabies, in cases where compliance with topical agents may be problematic, and in infants with severely inflamed or broken skin where prescription of topical therapies would likely cause cutaneous and systemic toxicity. Additional high-quality studies are needed to guide best practice in the management of infantile scabies.

Extragenital Phthiriasis: Diagnosis Made Simple by Dermoscopy.

A 21-year-old, otherwise healthy, man presented with a 2-week history of black spots on his lower extremities and buttocks associated with pruritus. On clinical examination, black structures within dense hairs and bilateral inguinal lymphadenopathy were present. Handheld dermoscopy (magnification ×10, Dermlite D4; 3Gen, Juan Capistrano, CA) showed multiple living crab-shaped organisms, consistent with Phthirus pubis, as well as nits attached to the hair shafts; neither could be clearly identified by the naked eye only (Figs. 1, 2; Video 1 [https://links.lww.com/OLQ/A659]). No insects were present in previously shaved genital area. The screening for other sexually transmitted diseases was negative. The patient was successfully treated with 5% topical permethrin and hair removal.Figure 1: Phthirus pubis. aAdult parasite grasping hairs with claws, visible blood within the digestive system. bAdult parasite sucking blood with mouth inserted into the skin.Figure 2: Phthirus pubis. aAdult parasite. bNit. cMacula cerulea.A study by Truesdale et al.1 reported that weighted percentages of pubic hair grooming in women and men in the United States equal 85.3% and 66.5%, respectively. Because of increased pubic hair removal, extragenital P. pubis infestation in hair-bearing areas such as eyebrows, eyelashes, mustache, beard, axillae, and trunk may be more commonly observed.2,3 Because P. pubis is smaller, lighter, nearly transparent, and not as mobile as other lice, the diagnosis of human phthiriasis by the naked eye only may be more difficult.4 There are a few reports on the usability of dermoscopy (entomodermoscopy) in diagnosing of human pthiriasis. This method may be performed both ex vivo and in vivo.2 To our knowledge, this is the first description of the usability of dermoscopy in vivo in extragenital pthiriasis of the lower legs and buttocks. Dermoscopy in vivo enables visualization of the life cycle of P. pubis with empty nits (with flattened ends), nits containing nymphs (brown and ovoid), nymphs, and adult organisms.5 Handheld dermoscopy is a simple and quick method in diagnosing extragenital phthiriasis.

Study of efficacy and cost effectiveness of topical permethrin, benzyl benzoate and oral ivermectin in the treatment of scabies

Background: Scabies is an ectoparasitic infestation caused by the mite Sarcoptes scabiei var hominis that occurs due to direct skin to skin contact.It is a common public health problem that affects humans regardless of age, gender and social class.An ideal scabicide should be effective against both adult and egg of the mite, easily applicable, acceptable, nontoxic, and economical. It should be safe to use in all ages. Objectives: To compare the therapeutic efficacy and cost effectiveness of topical 5% permethrin, 25% benzyl benzoate and oral ivermectin (200mcg/kg/dose) in the treatment of scabies. Materials and Methods: A total of 90 patients with scabies attending the dermatology outpatient at the Department Of Dermatology, Venereology and Leprosy, Adichunchanagiri Hospital and Research Centre, B.G. Nagara, were randomly divided into three treatment groups A, B and C with 30 patients in each group. Group A patients received 5% permethrin cream which was made to remain in contact with the skin for at least 8 hours. This was repeated after 7 days. Group B patients received 25% benzyl benzoate lotion which was made to remain in contact with the skin for at least 8 hours. This was done for three consecutive nights. Group C patients received oral ivermectin in a single dose of 200mcg/kg body weight taken with meals and it was repeated after 10 days. All patients were followed up at the end of first, second and third week to assess clinical grading score and pruritus grading score by visual analogue scale. The cost effectiveness was calculated on basis of total expenditure on medicine at the end of the third week and cure rate of the three groups were compared on the basis of amount needed to treat one case successfully. Results: At the end of third week, complete clinical cure was seen in 28 (93.3%) patients in group A, 13 (43.3%) patients in group B and 22 (73.3%) of patients in group C. Permethrin was more efficacious than benzyl benzoate and ivermect

Treatment practices in the management of scabies in infants younger than two months.

Efficacy and safety data of scabies treatments in infants are limited. Although topical permethrin is used in the treatment of scabies in adults, it is not approved for use in infants younger than 2months of age in many parts of the world. This study aimed to describe treatment practices in the management of scabies in infants younger than 2months. An online survey was developed and distributed to physicians worldwide through the Society of Pediatric Dermatology and the Pediatric Dermatology Research Alliance. Data collected included demographics, medication availability, experience using medications, deterrents to medication use, medication administration preferences, perceived and experienced medication side effects, and preferred treatment agent in this population. In total, 57 physicians from seven countries responded. The majority of respondents were board-certified in pediatric dermatology (48/57, 84.2%) and resided in the United States (44/57, 77.2%). Respondents had experience using permethrin (47/57, 82.5%) and precipitated sulfur (35/57, 61.4%) most frequently. Most (38/57, 66.7%) preferred permethrin as their treatment of choice. Among those who did not use permethrin, potential side effects (8/10, 80%) were most frequently reported as a deterrent from its use. However, only 4.3% (22/47) of those who used permethrin reported side effects, including itching, erythema, and xerosis. Permethrin is frequently used in the treatment of infants younger than 2months with scabies. Furthermore, our results demonstrate that permethrin is the preferred treatment agent among sampled dermatologists for infants younger than 2months. Few side effects were reported, and none were serious.

Scabies with Secondary Infection Resembling Kerion-Type Tinea Capitis

Scabies is an infestation caused by the mite Sarcoptes scabiei var hominis. The clinical picture can vary and in children, scabies occurs in locations that are not usually found in adults. Complications can occur due to secondary impetiginization of scabies lesions. We presented a case of 8-year-old boy with painful red lumps, pus discharge, and alopecia on the back of the head since 2 weeks ago. Dermatological examination revealed multiple erythematous nodules with sinuses in the scalp of the parieto-occipital area and alopecia. Through microscopic examination we found the Sarcoptes scabiei mite; therefore, we conclude that the diagnosis in this patient was impetigenic scabies. Treatment with topical permethrin 5%, oral antihistamine and oral antibiotics resulted in good outcome.

Scabies-Renaissance of an ectoparasite infection : Diagnosis and therapy-How to proceed in practice

Scabies or mange is currently acommon dermatosis in Germany and other countries, and should be more important in health policy. It affects across-section of society, including all age groups, from infants to the aged. Locals and people with amigration background both suffer from this highly contagious ectoparasite infection with excessive, predominately nocturnal itching. Clinical diagnosis represents achallenge for the experienced dermatologist due to the variety of dermatosis to be considered in the differential diagnosis. It is still unclear whether treatment failure or the recurrences observed everywhere are due to in vitro and in vivo resistance of the pathogen agent Sarcoptes scabiei against permethrin or ivermectin. Therapeutic errors seem to play arole as often not all direct contact persons are recorded and treated with antiscabious treatment. They form the reservoir for reinfections. In the event of repeated nonresponse to topical (permethrin) and/or oral antiscabious treatment, alternative topical preparations-benzyl benzoate or crotamiton-should be used. Combination with ivermectin is mandatory.

Efficacy and Safety of Oral Ivermectin and Topical Permethrin in the Treatment of Scabies

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice.
 Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies.
 Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. group A was subjected to oral Ivermectin and the group B to Permethrin 5% cream. Patients were followed up on day 7 and 14 for assessment of efficacy and safety.
 Result: The mean scoring with SD in group A (Ivermectin) and group B (Permethrin) were 8.26 ± 2.22 and 7.59 ± 2.01 respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) the mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7thdays. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001).
 Conclusion: Topical application of permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies.
 TAJ 2020; 33(1): 41-47

Efficacy & Safety of Oral Ivermectin and Topical Permethrin in the Treatment of Scabies

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice.
 Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies.
 Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. Group A was subjected to oral Ivermectin and the Group B to Permethrin 5% cream. Patient were followed up on day 7, 14 and assessed for the efficacy and safety.
 Result: The mean scoring with SD in Group A and Group B were 8.26 ± 2.22 and 7.59 ± 2.01respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) The mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7th days. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001).
 Conclusion: Topical application of Permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies.
 J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 91-95

"Stopping the itch": mass drug administration for scabies outbreak control covered for over nine million people in Ethiopia.

In 2018, the Ethiopian Ministry of Health embarked on a Mass Drug Administration (MDA) campaign that involved over 9 million people in Ethiopia - the largest scabies MDA campaign ever conducted on a global level. We describe its implementation and report on a) numbers screened and identified with scabies, b) treatment category and drug type and c) human resources used, duration, and cost of the campaign. The MDA campaign was conducted according to national guidelines and activities including: planning and organization, engagement of local leaders, community mobilisation and advocacy, awareness-raising among health workers, field implementation, and monitoring and evaluation. The campaign was conducted between July and August 2018. The MDA campaign was implemented by about 15,000 people, mostly from the community, over an average of 6 days and reached 9, 057, 427 people. A total of 875,890 (9.7%) scabies cases were detected and 995,471 (11.0%) contacts received treatment. (Contact-to-case ratio = 1.3). Scabies prevalence varied, the highest prevalence was seen in Central Gondar (39.2%), South Gondar (16.7%) and North Gondar (15.0%), these neighbouring zones contributing more than two third of all scabies cases in the region. Of 1,738,304 (93%) who received treatment, 94% received ivermectin, the rest topical permethrin and sulfur. The average coverage capacity of an MDA campaign staff member was 84 people per day. The total cost was 11,696,333 United States Dollars (USD). Cost per 100,000 population = 129,135 USD. This experience of rapid-large scale implementation would be useful to scale up similar interventions and "stop the itch" in other regions of Ethiopia.

‘Loss of efficacy of topical 5% permethrin for treating scabies: an Austrian single-center study’

Background Scabies is a contagious, itchy, parasitic infection of the skin. It is transmitted by skin-to-skin contact or by contact with contaminated material. Recent observations, especially in the outpatient setting, suggest there is decreasing efficacy of the standard treatment of choice, topical 5% permethrin cream. Objectives To assess the efficacy and safety of topical permethrin for scabies treatment in patients. Methods Patients visiting the Dermatology outpatient clinic with dermatoscopy-assured scabies were assessed for enrollment in the study. In total, 55 patients were enrolled and sequentially randomized into three groups. Group (A) received permethrin 5% cream on two occasions within a one-week interval, while (intensive) group (B) received the same administration of permethrin 5% cream plus the daily application of the cream on dermatoscopically verified affected sites (hands and/or genitals and/or feet). The treatment was evaluated at 3 weeks by dermatoscopy. Group A patients who failed to respond were allowed to repeat the treatment according to the group B scheme and were again evaluated after 3 weeks (group C). Results Two applications of permethrin 5% cream (group A) produced a cure rate of 29% at follow-up. The intense application of permethrin 5% cream (group B) was not superior at follow-up (cure rate 31%). Patients who were retreated according to the intense scheme (group C) did not benefit at all. Conclusion Mite populations with reduced susceptibility to permethrin exist in Austria and necessitate the evaluation of alternative treatment regimens. Key Messages Human scabies is a rising major public health issue worldwide and has been designated as a neglected tropical disease by the World Health Organization. Resistance to permethrin, the most widely prescribed first-line therapy for scabies is to date underreported. At present, treatment recommendations remain controversially discussed as official guidelines do not address current development of resistances, and therefore their clinical applicability is limited.

Un eritema tossico neonatale… pruriginoso

A 3-month-old male infant was evaluated for the persistence of erythema toxicum neonatorum. Physical examination was remarkable for a papulopustular rash on his hands and feet, with similar lesions on his trunk. The baby was irritable and continuously rubbed his soles. The parents as well presented similar cutaneous lesions, which had been treated with anti-histamine drugs without effect. The suspect of scabies was therefore raised and eventually confirmed by the examination of the skin scraping sample, showing the presence of the mites. In both the infant and his parents the clinical picture resolved after two cycles of topical permethrin. In the neonatal age, scabies can act as a great mimicker. In front of any pruritic rash, it is therefore mandatory to search for affected relatives. In fact a prompt diagnosis is crucial to prevent the superinfection of the patient lesions, as well as epidemic outbreaks.

Application errors associated with topical treatment of scabies: an observational study.

In recent years, there has been a significant increase in scabies infestations throughout German-speaking countries. Given the high frequency of treatment failures, the question arises as to whether topical permethrin treatment is always performed correctly. Our department uses a fluorescent test cream to teach patients on how to correctly apply topical permethrin. In the context of a prospective observational study of 21 patients, we systematically assessed and analyzed potential application errors. None of the participants succeeded in adequately applying the cream to the entire skin as previously instructed. The median number of regions left untreated was six (minimum: 2; maximum: 18), which included a median body surface area of 6 % (minimum: 2 %; maximum: 30 %). With regard to predilection sites of scabies, the ankles were left untreated in 62 % of cases, followed by the interdigital spaces (toes) (33 %) and the sacral region (24 %). All patients considered the pretreatment training to be very useful. The present findings clearly demonstrate potential shortcomings when it comes to the application of topical antiscabies treatment. This may provide a (potentially underestimated) explanation for the large number of reports on treatment failures in this regard, which falsely suggest potential treatment resistance.

In vitro survival of scabies mites

The correct treatment and management of scabies is expensive, time consuming and may have negative impacts on patients and their families. We sought to investigate the effects of 5 % permethrin cream on scabies mites, and explore mite survival times outside the human body. We performed a non-randomised controlled study. Twenty petri dishes were coated with 5 % permethrin cream, each with one scabies mite (treatment group), and twenty plain petri dishes with one scabies mite each (control group) were observed at baseline and 3, 4, 5, 6, 7, 8 and 12 hours from baseline. In the second part of our study, thirty scabies mites from infested patients were investigated in an observational study in 30 plain petri dishes at days 0, 3 and 4. Our data showed that 65% of scabies mites survived after eight hours in the treatment group, when compared with 75% of mites in the control group. After 12 hours, 25% of mites in the treatment group, and 60% in the control group were still alive. Data from the observational survival study showed that one mite survived for three days, but all mites were dead by day four. This study showed no significant effects of mite survival times with 5 % topical permethrin after eight hours, while its efficacy was stronger and significant after 12 hours. We recommend the isolation of all mite-infested items for at least four days.

Prospective, randomized, and comparative study of efficacy of ivermectin, benzyl benzoate 25%, permethrin 5% and gamma benzene hexachloride 1% in the treatment of uncomplicated scabies

Background: Scabies is an infectious and contagious human skin disease. The aim of the study was to study the efficacy and safety of four different treatment modalities in clinically diagnosed cases of scabies of single dose of oral ivermectin and commonly used topical scabicidal agent’s benzyl benzoate 25% (BB), permethrin 5% and gamma benzene hexachloride 1% (GBHC).Methods: This study was carried out in the Department of Dermatology, Andhra Medical College, Visakhapatnam. 200 patients diagnosed of scabies were included in the study during the period from August 2013 to July 2014. The percentage of improvement was compared between four groups. Intergroup comparison between two groups was done Chi square test.Results: In the present study a greater number of patients were students (54.5%). Subsidence of lesion and itching with oral ivermectin given as a single dose (200 μg/kg body weight) was 45 (90%) and 44 (88%), with topical permethrin 5% lotion single application 48 (96%), 47 (94%), with topical GBHC 1% lotion 40 (80%) patients, 38 (76%). Topical application of BB lotion 25% was 38 (76%), and 36 (72%) at fourth week.Conclusions: In the present study permethrin 5% cream was found to be more effective among topical agents. Both BB and GBHC 1% lotion are being inexpensive and they can be used as an alternative treatment in developing country like India.

Scabies: A Neglected Global Disease.

Scabies is a skin disease caused by an obligate human parasite mite Sarcoptes scabiei var. hominis. Children under the age of two and elderly individuals are at the greatest risk. Knowledge of this condition is important for an early diagnosis to be made and treatment to be initiated. The review aimed to familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of scabies. A search was conducted using Pubmed with the built-in "Clinical Queries" tool. The search term "Scabies" was used. The categories of "epidemiology", "diagnosis", "therapy", "prevention" and "prognosis" had a limited scope for primary clinical studies. Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles. Worldwide, scabies affects 200 to 300 million individuals annually. The average prevalence is estimated to be 5 to 10% in children of developing countries. Transmission usually occurs after close prolonged skin-to-skin contact. Classic scabies is characterized by an erythematous papular eruption, serpiginous burrows, and intense pruritus. Sites of predilection include the webs of the fingers, volar wrists, lateral aspects of fingers, extensor surfaces of elbows and knees, waist, navel, abdomen, buttocks, groins, and, genitals. A clinical diagnosis of classic scabies can be made on the basis of the history and clinical findings. Other clinical variants include crusted scabies, nodular scabies, and bullous scabies. Finding the mite, ova, or fecal pellets on microscopic examination of scrapings taken from skin lesions confirms the diagnosis of scabies infestation. For eradication of scabies mites, the drugs of choice are topical permethrin and oral ivermectin. Scabies is a highly contagious parasitic cutaneous disease that is stigmatising and debilitating. Increased awareness, accurate diagnosis, and prompt treatment are essential for the effective control of scabies and for the prevention of the spread of the disease.

Modeling the behavioral and metabolic phenotype of mice exposed to Gulf War toxicants

Gulf War Illness (GWI) is a chronic multi‐symptom condition that still affects a third of veterans who served in the 1991 Persian Gulf War (GW). Latently‐emerging and persistent symptoms fall into 5 general domains: neurological/cognition/mood (memory, concentration, anxiety, depression), muscle/joint pain, respiratory, gastrointestinal disturbances and especially chronic fatigue. GWI remains untreated due its poorly understood etiology and pathophysiology. It is suggested that GWI is a result of continuous exposure to GW agents administered to protect military personnel: 1) acetylcholinesterase inhibitor pyridostigmine bromide (PB) taken orally as prophylaxis against nerve agents, 2) topical insecticide permethrin (PER), and 3) topical insect repellent diethyltoluamide (DEET). Although GW agents were administered at safe doses, their chronic and combined use, in addition to stress, a critical component of GW deployment, may produce and/or intensify the pathophysiology of GWI for reasons not fully understood. Additionally, GW veterans report symptoms associated with delayed‐onset Type II diabetes mellitus, which may be associated with chronic fatigue. To further investigate the behavioral, metabolic manifestations of GWI pathophysiology, we studied the effects of acute (AE) and chronic (CE) GW toxicant exposure in adult C57Bl/6N males utilizing a repeated measures design. The AE model consisted of 1wk exposure to PB (2 mg/kg/d; ip), PER (200 mg/kg/d in 70% ETOH; top), DEET (40 mg/kg/d in ETOH; top) and 5 min restraint stress/d (n=4–7). The CE model consisted of 5 days/week for 28 days of exposure to PB (13 mg/kg/d; po), PER (1.3 mg/kg/d; top) in 70% ETOH, DEET (40 mg/kg/d in ETOH; top) and stress 5min/d (n=6–8). A sham control was also tested in CE experiments. Behavioral and metabolic endpoints were measured at one week post treatment (PT) and 60d PT (AE) and 90d PT (CE) to model the delayed and persistent effects seen in GW veterans. When compared to pre‐treatment, GW mice exposed to CE paradigm showed depressive‐like behavior on forced swim, tail suspension and hanging wire tests at post‐treatment. On elevated platform (SUOK) test AE and CE produced sensorimotor alterations as measured by an increased number segments crossed CE decreased missteps/segments crossed relative to pre‐treatment. Increased anxiety was observed as decreased risk assessment (CE) and increased vegetative behavior in AE on SUOK and in AE and CE as less percent time spent in open arm of an elevated plus maze. GW agent exposure had no effect on three‐chambered sociability test. Both CE and AE groups displayed transient but marked insulin insensitivity relative to pre‐treatment. These results show that GW agents can produce insulin insensitivity along with altered sensorimotor integration, anxiety and depressive‐like behavior. In comparison to GW effects on anxiety which persisted at 90d PT (with the exception of vegetative behavior), the depressive‐like effects normalized at 90d PT. Our findings will help inform studies that aim to elucidate the etiology and pathophysiology of GWI.Support or Funding InformationAmerican Physiological Society (AB) and UC Minigrant (AB and JT).

EFFICACY OF WHITE-TAILED DEER (ODOCOILEUS VIRGINIANUS) TREATMENT FOR CATTLE FEVER TICKS IN SOUTHERN TEXAS, USA.

White-tailed deer (Odocoileus virginianus) serve as a host for cattle fever ticks (Rhipicephalus [Boophilus] microplus and Rhipicephalus [Boophilus] annulatus; CFTs); therefore, deer are a concern for CFT control programs in southern Texas, US. Systemic (oral delivery of ivermectin) and topical (permethrin on pelage) treatment devices have been developed for white-tailed deer; however, the efficacy of these treatment options has not been determined for CFTs in southern Texas. Our objectives were to evaluate the effectiveness of CFT treatment strategies by 1) measuring exposure rates of deer to the acaricides permethrin and ivermectin, 2) determining the relationship between CFTs on deer and exposure to the acaricides, and 3) determining if photos from remote cameras at medicated bait sites can be used as a measure of acaricide treatment. We captured 327 deer at four sites in southern Texas. Deer visitation to medicated bait sites was monitored using remote cameras from March 2010 to February 2012. There was no relationship between the presence of permethrin and the probability of being infested with CFTs (P≥0.336). The probability of infestation with CFTs decreased as serum ivermectin levels increased for male (n=18, P=0.098) and female (n=33, P<0.001) deer. Our results indicate ivermectin may be more effective in treating CFTs than permethrin; thus it would be worthwhile to develop topical acaricides other than permethrin for treating white-tailed deer in southern Texas.

A comparative study to assess the efficacy of permethrin (topical) and ivermectin (oral) in scabies patients seeking care at a tertiary care teaching hospital of northern India

The evidence for the superiority of Ivermectin (Oral) over topical preparations in the treatment of scabies conclusively lacks at present. Randomized controlled trials comparing ivermectin with topical permethrin have provided us the inconclusive results.To comparatively assess the efficacy of permethrin (topical) and ivermectin (oral) in scabies patients.After enrolling 178 study subjects, they were equally distributed to two study groups (I &amp; II) and were given the desired respective therapeutic medication or interventions. Subjects in Group I was given permethrin 5% cream, and subjects in Group B were given a single dose of tablet ivermectin orally (200 mcg/kg). Efficacy of two groups of drugs was compared in terms of improvement in clinical grading of disease (%) &amp; development in clinical grading of pruritus (%) during follow up visits at the end of 1, 2, 4 &amp; 6 weeks.The mean age (± SD) for study subjects in Group I was 18.18 ± 11.33 years, whereas, in the Group II, it was 25.185 ± 10.67 years. The clinically observed cure rate among two groups i.e., Permethrin and Ivermectin at the end of the first and second weeks were 72% and 40%, and 96% and 58%, respectively. Rapid improvement in itching was noted down among subjects receiving topical permethrin as compared to those who received oral ivermectin. Comparatively, during different visits, permethrin provided better and fast improvement in itching grade than ivermectin.The improvement in scabies clinical grade and itching grade for permethrin (topical) was found to be more efficacious in comparison to ivermectin (oral).

Can we treat scabies adequately using topical medication? Retrospective analysis of 74 patients

Aim: Scabies is a contagious parasitic skin disorder, which is characterized by severe pruritus. Scabies usually presents with papules and excoriations on hands, feet, axillae, umbilicus and genitalia. Recently, both increased prevalence of the disease and resistance to anti-scabies treatment have been reported. Therefore, early diagnosis and appropriate treatment of scabies are crucial. The aim of this study was to evaluate the characteristics of patients with scabies and treatments that the patients received in order to provide successful management of scabies.Material and Methods: Medical records of the patients who were diagnosed with scabies between June 2019 and February 2020 were reviewed retrospectively. Age, gender, disease duration, similar symptoms in household members, dermatological examination, prior treatments and treatments that we recommended were recorded.Results: The study included 74 patients (39 female, 35 male) with scabies. The mean age of the patients was 40.6±16.7 years. The mean disease duration was 53.5±5.5 days. Pruritus was observed in the household members of 37 (50%) patients. 18 (24.3%) patients received only symptomatic treatment since they were diagnosed as other pruritic dermatoses including xerosis or dermatitis, previously. However, we treated 58 (78.4%) patients using topical permethrin 5%. In addition, 4 (5.4%) patients were treated with topical sulfur 12.5% and 3 (4.1%) patients were treated with balsam of Peru. 9 (12.2%) patients who were resistant to topical treatment received oral ivermectin for complete cure of scabies. Conclusion: The results indicated that most of the patients with scabies (78.4%) were treated with topical permethrin successfully, whereas 12.2% patients required oral ivermectin in addition to topical anti-scabies treatment. Nevertheless, delay in diagnosis of 24.3% patients might increase the risk of spread of scabies. Therefore, we recommend topical permethrin, oral ivermectin and immediate further clinical and laboratory evaluation for indeterminate cases.