Pseudoresistance to permethrin in scabies

Veraldi, Stefano; Schianchi, Rossana; Silvio, Martina; Aromolo, Italo Francesco

doi:10.3855/jidc.17750

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…In recent years, it was reported an increasing number of cases of persistence of symptoms and signs after treatment (Lluch-Galceráet al, 2023). It can be due to several causes of resistance (Pasay et al, 2008;Khalil et al, 2017;Yürekli, 2022) and pseudo-resistance (Cox, 2000;Nemecek et al, 2020;Scholz et al, 2023;Veraldi et al, 2023). Our aim is to show that there was no resistance to Permethrin, but the patients' failure to respond to treatment is attributes to incorrect application of treatment and so to the so-called pseudo-resistance.…”

Section: Discussionmentioning

confidence: 88%

“…Some common factors contributing to pseudo-resistance include inadequate counseling by physicians and incorrect treatment, such as administering an insufficient quantity of Permethrin (Cox, 2000); additional factors leading to pseudoresistance encompass the inadequate duration of treatment (a treatment course that is too short), suboptimal adherence and compliance by patients (Veraldi et al, 2023), and reduced bioavailability of the prescribed treatment. The updated European guidelines for the management of scabies (Salavastru et al, 2017) report that "Permethrin 5% cream has to be applied head to toe and washed off after 8-12 h of application.…”

Section: Causes Of Pseudo-resistancementioning

confidence: 99%

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Resistance and Pseudo-resistance to permethrin: the importance of controlling scabies

Rinaldi,

Chirico,

Trink

et al. 2023

Front. Cell. Infect. Microbiol.

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Ion channels are proteins embedded in the cell membrane, creating openings, called "pores", frequently become the focal points of neurotoxins (Wakeling et al., 2012).. Permethrin acts on the nerve cell membrane by disrupting the function of voltage-gated sodium channels (VGSCs). This results in delayed repolarization and subsequent paralysis and death of the parasite in all stages (Lobo and Wheller, 2021). VGSCs comprise a central subunit that forms the pore (a subunit) and an additional auxiliary subunit. The a subunit contains four domains (I-IV) each with 6 transmembrane segments (S1-S6). The channel pore, responsible for Na+ selectivity, is constituted by the fifth and sixth transmembrane segments (S5 and S6) along with the interconnecting loop. The S4 segments, containing positively charged amino acids, act as voltage sensors, instigatingFrontiers in Cellular and Infection Microbiology frontiersin.org 01

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Section: Discussionmentioning

confidence: 88%

Section: Causes Of Pseudo-resistancementioning

confidence: 99%

Resistance and Pseudo-resistance to permethrin: the importance of controlling scabies

Rinaldi,

Chirico,

Trink

et al. 2023

Front. Cell. Infect. Microbiol.

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“…There have been cases of pseudo-resistance to the treatment of scabies reported in the literature, which can be attributed to several factors. First, inadequate counseling of patients by medical professionals can result in patients not fully understanding the treatment protocol correctly [ 15 ]. Second, improper practices, such as insufficient quantity or duration of permethrin application, can result in the persistence of scabies infestations [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, scabicidal therapy proves ineffective in these patients, and the condition may persist for weeks or months. Post-scabetic prurigo tends to be more prevalent in male children and follows a chronic-relapsing course, with recovery often achieved through the use of potent topical corticosteroids [ 15 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

The Itchy Truth About Scabies: A Case of Asymptomatic Carrier Transmission and Treatment Failure

Hesari,

Schur,

Tyndall

et al. 2023

Cureus

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Scabies, a common and highly contagious skin infestation, is caused by the mite Sarcoptes scabiei var. hominis . Identifying individuals with scabies often poses a diagnostic challenge, as its clinical features resemble other dermatologic conditions such as drug reactions, atopic dermatitis, and contact dermatitis. Furthermore, the cutaneous manifestations arise from delayed-type immunologic reactions to the mites and their byproducts, allowing some individuals to carry the mite without showing symptoms. The significant transmissibility of scabies, along with the potential for asymptomatic carriers, creates multiple treatment hurdles for cohabiting individuals, as the failure to treat all close contacts can result in re-infestation. This report presents the case of a 46-year-old Vietnamese male who suffered from a worsening erythematous, scaly, and pruritic rash for four months. Despite being prescribed topical corticosteroids by three different dermatologists, his rash persisted. Upon thorough evaluation, scabies was diagnosed. The patient was treated with scabicidal agents, which initially alleviated his symptoms; however, three weeks later, his symptoms resurfaced. Further investigation revealed that his wife was an asymptomatic carrier who had not received treatment. This case highlights the clinical features, pathogenesis, and treatment options for scabies while emphasizing the importance of promptly identifying and treating all close contacts.

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Two‐year, single‐centre, real‐life experience with permethrin 5% and benzyl benzoate 25% in 228 children with scabies: A retrospective report

Restano,

Brusasco,

Cappadona

et al. 2023

JEADV Clinical Practice

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BackgroundScabies are a significant health issue for institutions and represent a health burden in children. Topical treatments such as permethrin 5% are usually effective but lately, a loss of efficacy has been observed.ObjectivesTo describe demographic data, topical treatment schemes (permethrin 5%; benzyl benzoate 25%) and outcomes in children with scabies over the past 2 years.MethodsWe retrospectively evaluated records of children aged 0 to 14 years with scabies treated in our outpatient clinic from 1 January 2021 to 31 December 2022.ResultsTwo hundred and thirty‐one records were evaluated. Permethrin 5% (P5%) was used as first‐line treatment in 103 children with a success rate of 81.5%; benzyl benzoate 25% (BB25%) was successful in 94.3% of 123 patients. Three patients were lost for follow up and two received other therapies. Mean days of application using P5% increased from 4.1 to 6.8 in 2 years, whereas BB25% showed an opposite trend, from 10 days to 4.7. With the same days of application, the success rate with BB25% was higher (repeated cycle of 2 treatment days, 7 days apart [2 + 2]: 93.3% for BB25% vs. 82.9% for P5%; 3 + 3‐day regime: 91.9% for BB25% vs. 83% for P5%). Twenty‐three out of 26 patients who still had active scabies after the first cycle cleared with a second treatment cycle, with the same topical treatment, or with a different agent. Mild to moderate skin irritation was the only side effect observed (18.4%), more frequently associated with BB25% (81%).ConclusionsDuring the observational period, the use of permethrin decreased while regimen duration increased, probably due to a perceived lack of efficacy. Conversely the use of benzyl benzoate both as first‐line treatment and after permethrin failure increased, despite being more correlated to local inflammation. Both 2 + 2 and 3 + 3 regimes for P5% and BB25% may be considered as suitable first‐line treatment of scabies in children.

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Pseudoresistance to permethrin in scabies

Cited by 6 publications

References 8 publications

Resistance and Pseudo-resistance to permethrin: the importance of controlling scabies

Resistance and Pseudo-resistance to permethrin: the importance of controlling scabies

The Itchy Truth About Scabies: A Case of Asymptomatic Carrier Transmission and Treatment Failure

Two‐year, single‐centre, real‐life experience with permethrin 5% and benzyl benzoate 25% in 228 children with scabies: A retrospective report

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