THE EFFICACY AND SAFETY OF PERMETHRIN-BASED MEDICATIONS FOR THE TREATMENT OF SCABIES IN CHILDREN: A COMPREHENSIVE SYSTEMATIC REVIEW

Abstract

Introduction: Scabies, a parasitic infestation caused by Sarcoptes scabiei, is a significant global health issue, particularly burdening the pediatric population with intense pruritus and the risk of severe secondary bacterial complications. Permethrin 5% cream is globally recommended as the primary treatment. However, a periodically updated, consolidated overview of its efficacy and safety profile specifically within the pediatric demographic is crucial for reinforcing evidence-based clinical guidelines. This systematic review aims to comprehensively evaluate and synthesize the existing evidence on the efficacy and safety of permethrin-based medications for treating scabies in children. Methods: A systematic literature search was conducted in PubMed, Scopus, the Cochrane Library, and Google Scholar for studies published up to December 2025. The review included randomized controlled trials (RCTs), cohort studies, and large case series that assessed the efficacy or safety of 5% permethrin cream in patients aged 0-18 years with a confirmed scabies diagnosis. The primary outcomes were the cure rate at four weeks and the incidence, nature, and severity of adverse events. Data were extracted independently by two reviewers, and the methodological quality of included studies was rigorously assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for observational studies.  Results: The search yielded 1,245 articles. Following a rigorous screening process, 22 studies met the inclusion criteria, encompassing a total of 3,890 pediatric patients from diverse geographical regions. The reported cure rates for a single application of 5% permethrin cream ranged from 78% to 98% at the four-week follow-up. Studies that implemented a protocol of a second application one week after the first consistently reported superior cure rates, frequently exceeding 95%. Adverse effects were overwhelmingly local and transient, with mild erythema, stinging, and burning sensations at the application site being the most common, occurring in less than 10% of patients. Systemic adverse reactions were exceptionally rare, and no serious long-term side effects were reported. The evidence strongly supports the safe use of permethrin in infants as young as two months old.  Discussion: The synthesized evidence robustly confirms that 5% permethrin cream possesses high therapeutic efficacy and an excellent safety profile for treating scabies in children. Its neurotoxic action on the mite, combined with minimal systemic absorption and rapid metabolism in humans, underpins this favorable profile. The review underscores the critical importance of a second application to eradicate newly hatched larvae, ensuring comprehensive treatment and preventing relapse. The common phenomenon of post-scabietic pruritus was identified as a key counseling point, representing a hypersensitivity reaction rather than an active infestation or treatment failure. Conclusion: Based on extensive evidence, 5% permethrin cream remains the undisputed gold-standard treatment (toci) for scabies in children. Its high efficacy and excellent safety profile make it the treatment of choice across all pediatric age groups above two months. Optimal clinical outcomes depend on meticulous application technique, a routine two-dose regimen, and the simultaneous treatment of all household contacts to prevent re-infestation.