Treatment of Scabies Using 8% and 10% Topical Sulfur Ointment in Different Regimens of Application

March 2012 | Volume 11 | Issue 3 | Original Article | 357 | Copyright © March 2012

Background: Many therapeutic modalities for scabies were available, topical sulfur ointment is a cost-effective and safe therapeutic agent. It is often applied for the whole body for three successive days.
Objective: To evaluate their therapeutic regimen of 8% and 10% topical precipitated sulfur in petrolatum ointment for single day, three successive nights or three successive days in management of scabies.
Patients and Methods: This single-blinded, comparative study was conducted in the Department of Dermatology-Baghdad Teaching Hospital from April 2008 through October 2009. A total of 97 patients with scabies were enrolled in this study. The diagnosis was established on clinical basis. The patients treated with 8% and 10% topical sulfur in petrolatum ointment were divided randomly into three groups: Group A: 33 patients treated for single day (24 hours); Group B: 32 patients treated for three successive nights (from 6 p.m. to 8 p.m. to 6 a.m. to 8 a.m. and bathing every day); and Group C: 32 patients treated for three successive days (bathing every 24 hours). The patients were seen regularly every two weeks for the duration of four weeks.
Results: Study included 58 (59.8%) males and 39 (40.2%) females, with a male to female ratio 1.4:1. The age range of males at presentation from 3 to 64 (26.74±15.98) years, while the females age ranged at presentation from 3 to 60 (24.05±14.53) years of age. At the end of the study, the response to treatment was: Group A, response in 14 (42.4%) patients and no response in 19 (57.6%); Group B, response in 29 (90.6%) patients and no response in 3 (9.4%); and Group C, response in 31 (96.9%) patients and no response in 1 (3.1%). There is significant statistical difference among the response of 3 groups with (P=0.00000011), but no statistically significant difference between the response of Group C and Group B, (P=0.6055). Mild burning sensation and irritating (sulfur) dermatitis were the only side effects of 8% and 10% sulfur. Pruritic rash occurred in Group C mainly, in 11 (34.4%) patients, 8 (25%) in Group B and 4 (12.1%) in Group A, with no significance (P=0.1058). Recurrence or relapse occurred in Group A mainly, with 4 (12.1%) patients, and in Group B, 1 patient, (3.1%), with no recurrence in group C, with significance (P=0.0060).
Conclusion: Three successive days and three successive nights of 8% and 10% sulfur ointment were effective regimens with no statistical difference in favor of three successive days, while single-day application was much less effective but with fewer side effects.

J Drugs Dermatol. 2012;11(3):357-364.


Human scabies is undoubtedly an ancient disease.1 Scabies is a human skin infestation; there are about 300 million cases of scabies in the world each year.2 The disease is caused by the mite Sarcoptes scabiei, variety hominis, an arthropod of the order Acarina, a member of the family Sarcoptedae, which includes three important genera of no medical importance.1 The adult female Sarcoptes scabiei have the major role in the pathogenesis of scabies, while the adult male, nymphs, larvae, eggs, and Scybala have lesser effect in the causation of disease.3 The average number of mites a host harbors is usually less than 20, except in "crusted scabies," in which a host may harbor over a million mites.4 It is an obligate human parasite that lives its entire life cycle in and on the skin.5 Several topical therapies have been used and found to be effective, including gamma benzene hexachloride (Lindane 1%), benzyl benzoate 25%, crotamiton 10%, permethrin 5%,5 ivermectin 1%,6 and tea tree oil (5%).7 Oral treatments include ivermectin,5 thiabendazole, and flubendazole.8 Although effective, some are expensive and may cause serious side effects.5