Oral Albendazole as an Alternative Treatment for Moderate Crusted Scabies Along with 5% Permethrin and 5% Salicylic Acid

Abstract

Crusted scabies (CS) is a severe variant of scabies, highly contagious, caused by numerous Sarcoptes scabiei (S. scabiei ) infestation. CS is associated with immunosuppressive conditions, like systemic lupus erythematosus (SLE). Various topical and oral scabicidals are used in the treatment of CS, including topical sulfur compounds, benzyl benzoate, crotamiton, lindane, malathion, permethrin, and ivermectin. The treatment of CS does not only need scabicidals, but also keratolytic agents to remove the thick crusts. The severity of CS is classified into three levels and related to the dose of oral ivermectin treatment. When oral ivermectin is not available, oral albendazole can be used as an alternative treatment. A case of CS in a 21-year-old girl with SLE was reported. Physical examination showed multiple lesions in the form erythematous papules, plaques, scales, and hyperkeratotic crusts in almost all parts of the body. The distribution of crusting >30% body surface area, the depth of crusting >10 mm, and there were pyoderma. Sarcoptes scabiei, eggs, and scybala were found on skin scraping. The patient was diagnosed as a moderate CS and treated with occlusive dressings using 5% salicylic acid in vaseline until crusts fell off, 5% permethrin cream three times per week, and 800 mg/day albendazole three consecutive days per week. A clinical and microscopic cure was achieved at day 19 of observation. Albendazole is an antiprotozoal agent with larvicidal effect, therefore it can be used as an alternative treatment of CS when oral ivermectin is unavailable, along with 5% permethrin and 5% salicylic acid.

An itchy rash with multi-regional crusts and scalp erosion

“…Topical permethrin is the treatment of choice for classic scabies, while combined use of topical permethrin, keratolytics (urea or salicylic acid ointment), and oral ivermectin is first line therapy for crusted scabies 135. Debulking crusts can decrease mite burden and increase permeability of topical scabicides 36. Albendazole, an anti-helminthic and antiprotozoal agent, offers an alternative treatment for crusted scabies when oral ivermectin is unavailable 6.…”

“…Debulking crusts can decrease mite burden and increase permeability of topical scabicides 36. Albendazole, an anti-helminthic and antiprotozoal agent, offers an alternative treatment for crusted scabies when oral ivermectin is unavailable 6. Household contacts should be treated concurrently with topical permethrin or oral ivermectin, even if asymptomatic 34.…”

Albendazole Oral sebagai Alternatif Pengobatan Skabies

“…Tingkat kesembuhan ivermectin oral adalah rendah apabila hanya diberikan sekali karena terbatasnya aktivitas ovicidal ivermectin serta waktu paruh yang pendek pada kulit. 4 Saat ini terdapat beberapa penelitian penggunaan albendazole oral 6,7,[11][12][13][14] Pada sebuah artikel manajemen terapi skabies pada abad 21, dikatakan bahwa terapi kombinasi ivermectin dan albendazole untuk filariasis limfatik dan onkoserkiasis, atau skabies dengan filariasis limfatik, atau skabies dengan strongiloidiasis menunjukkan hasil yang lebih efektif dan aman. 4 Di Zanzibar, Tanzania, pada pengobatan massal tahunan dengan ivermectin dan albendazole untuk filariasis limfatik dari tahun 2000 -2005, didapatkan persentasi klinis skabies turun sebesar 68%-98%.…”