Single application of Permethrin and two doses of Ivermectin have Comparable Efficacy in Scabies Treatment: Study

A new study published in the Indian Journal of Community Medicine revealed that oral ivermectin is just as effective as the commonly prescribed topical permethrin lotion in curing scabies, while also being cheaper and more convenient to use.

Scabies, a highly contagious skin infestation caused by the Sarcoptes scabiei mite, continues to be a public health concern, especially in crowded living conditions. Delayed diagnosis and improper treatment often allow the disease to spread rapidly, leading to community-wide outbreaks. Traditionally, 5% permethrin lotion applied over the entire body has been the standard treatment. However, compliance can be difficult due to the need for careful, time-consuming application.

To compare treatment effectiveness, this study enrolled 100 individuals diagnosed with mild to moderate scabies. The participants were randomly divided into 2 groups, where one group received oral ivermectin at a dose of 200 micrograms per kilogram of body weight on day one and again on day seven. Their household contacts were also treated in the same way. The other group received a single whole-body application of 5% permethrin lotion, with their contacts treated similarly.

All participants were followed up between 4 and 6 weeks after treatment to assess cure rates. The results were similar between the two groups. About 90.7 percent of patients in the ivermectin group were cured, when compared to 93.3 percent in the permethrin group. Also, among those with mild to moderate scabies who completed treatment correctly, the cure rate reached 100 percent in both groups, after two doses of ivermectin or one complete application of permethrin.

Although both treatments were effective, ivermectin stood out as the more economical option. Because it is taken orally, it eliminates many of the challenges linked to topical application, such as missing skin areas, improper use, or discomfort that can reduce adherence.

The study showed comparable demographic profiles between the two groups, ensuring that age, sex, and disease severity did not bias the outcomes. Treatment response tables indicated near-identical cure proportions, while cost-comparison data highlighted lower per-patient expenses in the ivermectin arm.

Also, follow-up records also showed fewer complaints about inconvenience among those taking oral medication compared to those applying lotion. Overall, the study confirms that two doses of oral ivermectin provide cure rates comparable to a single full-body application of 5% permethrin lotion.

Reference:

Pal, D., Behera, P., Ravichandran, M., Sahu, D. P., Sirka, C. S., Patro, B. K., Dash, S., & Taywade, M. (2025). Efficacy of two doses of ivermectin tablet in treatment of scabies in comparison to once application of 5% permethrin lotion - A randomized controlled trial. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 50(6), 969–974. https://doi.org/10.4103/ijcm.ijcm_278_24