Academic journal article Bulletin of the World Health Organization

Ivermectin versus Benzyl Benzoate Applied Once or Twice to Treat Human Scabies in Dakar, Senegal: A Randomized Controlled trial/Comparaison Entre L'ivermectine et le Benzoate De Benzyle En Une Ou Deux Applications Dans le Traitement De la Gale Humaine a Dakar Au Senegal : Essai Controle randomise/La Ivermectina Frente Al Benzoato De Bencilo Aplicado Una O Dos Veces Como Tratamiento De la Sarna Humana En Dakar

Academic journal article Bulletin of the World Health Organization

Ivermectin versus Benzyl Benzoate Applied Once or Twice to Treat Human Scabies in Dakar, Senegal: A Randomized Controlled trial/Comparaison Entre L'ivermectine et le Benzoate De Benzyle En Une Ou Deux Applications Dans le Traitement De la Gale Humaine a Dakar Au Senegal : Essai Controle randomise/La Ivermectina Frente Al Benzoato De Bencilo Aplicado Una O Dos Veces Como Tratamiento De la Sarna Humana En Dakar

Article excerpt

Introduction

Scabies is a globally occurring ectoparasitic infection whose burden has been estimated to be as high as 300 million cases per year. (1) In developing countries, scabies is a significant public health problem because it is highly prevalent and complications are frequent. It is one of the main reasons for consultations in non-specialized primary health-care centres. (2) Children appear to be more commonly affected and are at a significant risk of streptococcal superinfection, which may be complicated by acute glomerulonephrititis. (3) In addition, a recent study performed in the Gambia showed that skin lesions associated with scabies were the leading portal of entry for organisms that cause septicaemia in infants aged 3 months of less. (4)

Several topical treatments are effective: permethrin, lindane and benzyl benzoate (BB), with the last being considered the treatment of choice in most parts of Africa. On the other hand, oral ivermectin (IV) has also been shown to be effective, but the optimal number of courses is still a matter of some controversy. A recent meta-analysis (5) reported that, to date, there is no conclusive evidence that oral IV is superior to topical preparations for treating common scabies in the community setting.

We conducted a randomized controlled trial in Dakar, Senegal, to compare three modalities of treatment for scabies (i.e. oral IV and two forms of application of BB) with the aim of determining the most suitable treatment regimen in our setting.

Methods

Patients were included if they presented to the Institut d'Hygiene Sociale in Dakar, Senegal, and satisfied the following criteria: they were aged between 5 and 65 years; they were experiencing itching that involved at least three distinct sites on the body and had lesions that were characteristic of scabies (i.e. vesicles, papules, nodules or pustules) on at least three sites of predilection for scabies (i.e. the interdigital folds of the hands, the elbows, the wrists, the buttocks, the axillary folds, the nipple areolas in women and the male external genitalia), as assessed by a trained health-care worker; (6) and they were willing to participate in the study.

Patients were excluded if they satisfied any of the following exclusion criteria: there was doubt about the diagnosis of scabies; pruritus due to insect bites was present; the case patient or a member of his or her family had chickenpox; or the patient had been treated for scabies less than 1 month before the consultation; was under 5 years or over 65 years of age; weighed less than 15 kg; was pregnant or breastfeeding; was a women who used bleaching products for cosmetic purposes; had crusted scabies; had a general condition such as diabetes, high blood pressure or cardiovascular or neurological disease; or lived outside of the Dakar district. An HIV test was not required either before or after inclusion.

A parasitological examination was performed by low-power microscopy for each patient included in the trial. Skin scrapings were taken from each interdigital space in the hands and from the most clinically affected locations elsewhere. The scrapings were placed in a drop of 10% potassium hydroxide solution on a glass slide and examined for the presence of Sarcoptes scabiei (i.e. adult forms), eggs of faecal pellets. Negative findings on parasitological examination did not imply exclusion from the trial.

Setting

Senegal is a sub-Saharan country with 11 million inhabitants, and its capital, Dakar, has approximately 2 million inhabitants. The per capita gross national income is US$ 700. Forty per cent of the population lives in cities. The literacy rate is 50.4% in women and 72.8% in men. Fifty-seven per cent of the population is under 20 years of age. (7) The prevalence of HIV infection in the general adult population is estimated to be 0.8%. (8) Our unit is one of only two services that provide specialist dermatology care in Dakar. …

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