10.5826/dpc.1401a29
text/xml
2160-9381
3528
en
Andrea Sechi
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Topical Ivermectin for Permethrin-Resistant Scabies: A Useful Application
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2024-01-31
2023-05-10
2024-01-31
2024-02-21
e2024029
Dermatol Pract Concept
Andrea Sechi
2024/01/31
10.5826/dpc.1401a29
e2024029
Pediatric Dermatology, Ospedale dell’Angelo Venezia, Ospedale San Bortolo Vicenza, Italy
2160-9381
en
e2024029
Bassi A, Piccolo V, Argenziano G, Mazzatenta C. Topical ivermectin: an off-label alternative to treat neonatal Scabies in the era of permethrin resistance. J Eur Acad Dermatol Venereol. 2022;36(7):e557-e559. DOI: 10.1111/jdv.18026. PMID: 35188996.
Topical Ivermectin for Permethrin-Resistant Scabies: A Useful Application
https://dpcj.org/index.php/dpc/article/download/3528/2529
           Topical Ivermectin for Permethrin-Resistant
                  Scabies: A Useful Application
   Laura Gnesotto1, Mario Cutrone2, Carlo Mazzatenta3, Andrea Bassi3, Vincenzo Piccolo4,
                                     Andrea Sechi2


1 Dermatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
2 Pediatric Dermatology, Ospedale dell’Angelo Venezia, Ospedale San Bortolo Vicenza, Italy
3 UO Dermatology- Azienda USL Toscana Nord Ovest, Lucca, Italy
4 Dermatology Unit, University of Campania, Naples, Italy



Citation: Gnesotto L, Cutrone M, Mazzatenta C, Bassi A, Piccolo V, Sechi A. Topical Ivermectin for Permethrin-Resistant Scabies: A Useful
Application. Dermatol Pract Concept. 2024;14(1):e2024029. DOI: https://doi.org/10.5826/dpc.1401a29
Accepted: June 8, 2023; Published: January 2024
Copyright: ©2024 Gnesotto et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Andrea Sechi, Pediatric Dermatology, Ospedale San Bortolo, Vicenza 36100, Italy.
E-mail: andrea.sechi@aulss8.veneto.it




Case Presentation                                                        Teaching Point
A two-year-old child presented with multiple erythematous                Scabies is a highly contagious infection by Sarcoptes scabiei
papulo-nodular lesions on axillary folds and palms. Mites                var. hominis. Permethrin 5% cream is the first-line therapy;
were noted with dermoscopy, confirming a diagnosis of sca-               however, the emergence of permethrin-resistant scabies is
bies. The patient was initially treated with permethrin 5%               a growing concern. Alternative topical treatments for chil-
cream for three consecutive days and again one week later,               dren, including benzyl benzoate 25%, sulfur preparations,
without efficacy. Therefore, topical benzyl benzoate 25%                 and crotamiton 10% cream, may cause irritation or sys-
was applied thrice over a 24-hour period and repeated after              temic toxicity [1]. Ivermectin selectively targets and binds to
a week. At physical examination, no mites were noted on the              glutamate-gated chloride channels in the nervous system of
body, except for the scalp. Thus, an off-label administration            scabies mites; this interaction leads to increased permeabil-
of ivermectin cream 1% was prescribed, once a week for                   ity of chloride ions, hyperpolarization of nerve and muscle
two weeks. Improvement was evident immediately after the                 cells, and ultimately, paralysis of the parasite [1]. The use
first application, with complete remission of scalp lesions.             of oral ivermectin was contraindicated since our patient
No side effects or irritation were referred by the parents, and          weighed less than 15 Kg [1]. It is important to consider drug
no relapse occurred at one-month follow-up.                              resistance or the involvement of "unusual" sites such as the




Image Letter | Dermatol Pract Concept. 2024;14(1):e2024029                                                                              1
       Figure 1. (A) A crusted lesion on the scalp was visible during physical examination (yellow box). (B) Trichoscopy revealed
       the delta-wing jet sign (red arrow) at the end of the contrail sign (red box), which identified the female mite head and burrow,
       respectively. (C) Clinical resolution of scalp scabies observed 1 month after treatment.



periungual area or the scalp, when recalcitrant scabies is sus-          References
pected. Although there are limited studies on the safety and
efficacy of topical ivermectin 1% cream for classic scabies               1. Thompson R, Westbury S, Slape D. Paediatrics: how to man-
                                                                             age scabies. Drugs Context. 2021;10:2020-12-3. DOI: 10.7573
in adults, successful treatment has been reported in a few
                                                                             /dic.2020-12-3. PMID: 33828606. PMCID: PMC8007207.
infants [2].
                                                                          2. Bassi A, Piccolo V, Argenziano G, Mazzatenta C. Topical ­ivermectin:
                                                                             an off-label alternative to treat neonatal Scabies in the era of
                                                                             permethrin resistance. J Eur Acad Dermatol ­      Venereol. 2022;
                                                                             36(7):e557-e559. DOI: 10.1111/jdv.18026. PMID: 35188996.




2                                                                               Image Letter | Dermatol Pract Concept. 2024;14(1):e2024029
