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Ivermectin has been licensed for use against scabies only in France. However, its use on a named-patient basis has become widespread as a component of treatment for hyperkeratotic scabies in which it is often difficult to kill all the mites because of the limited penetration of the plaques by topical acaricides. In this condition, ivermectin can reach trophic mites by incorporation in the living cell layer on which the mites feed. However, ivermectin is unlikely to have any effect on mite eggs, and failures of treatment have been reported unless either dosing is repeated or a topical scabicide is used concurrently.55-57 So far no proper dosing studies using ivermectin have been performed, and the relative underdosing using both ivermectin and benzyl benzoate in one study indicates how important a contribution to knowledge this would be.43

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