Drawbacks

Generally, only minor adverse reactions have been reported for non-insecticide treatments for scabies. Most of these have been related to skin irritation, often following repeated or multiple applications of the formulation. The RCT comparing vehicles for sulphur ointment37 did not provide adequate data for a full analysis of effects. Side-effects were reported in patients and close contacts within 6 days of first being treated with either cold cream or pork fat with 1% salicylic acid: pruritus (31% versus 60%), xerosis (24% versus 34%), burning sensation (12% versus 17%), erythema (10% versus 2%), and keratosis (2% versus 15%).37 Where sulphur is used in developed countries it is normally applied in petroleum jelly and similar skin reactions have been reported as side-effects from case studies and series.36,41 Similar irritant reactions occur with repeat treatments using benzyl benzoate, particularly if naturally derived rather than synthetic material is used.36,42 In one RCT approximately 25% of people reported an increase in pruritus and dermatitis after treatment with two applications of 10% benzyl benzoate.43

Monosulfiram has been associated with a systemic adverse event in a number of case reports in which the people developed dermal oedema, flushing, sweating and tachycardia, especially after ingesting alcohol within 24 hours of treatment.44-46 This reaction occurs because monosulfiram is chemically related to disulfiram, used in the treatment of alcoholism (Antabuse).

Multiple applications of crotamiton can result in dermatitis and there is one report of a suspected link with methaemaglobinaemia.16,36,47

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