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

Background Scabies 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. Objectives To describe demographic data, topical treatment schemes (permethrin 5%; benzyl benzoate 25%) and outcomes in children with scabies over the past 2 years. Methods We 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. Results Two 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%). Conclusions During 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. Records of 231 children 0‐14 years treated for scabies with permethrin 5% and benzyl benzoate 25% were analyzed. During the study period (Jan 2021 ‐ Dec 2022) the use of permethrin decreased while regimen duration increased, due to lack of efficacy; conversely the use of benzyl benzoate increased, despite being more correlated to local inflammation. The overall success rate of a first line 2+2 days or 3+3 days regimen was 81.5% for permethrin 5% and 92.7% for benzyl benzoate 25%.