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Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Crotamiton is a topical scabicide and antipruritic agent. About 1 percent of topically applied dose is absorbed systemically. No studies of the use of this drug in pregnancy are published. It is an FDA category C drug.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Crotamiton is an enamide and tertiary carboxamide resulting from the formal condensation of crotonic acid with N-ethyl-2-methylaniline. It is used in the treatment of pruritus by producing a counter-irritation: as it evaporates from the skin, it produces a cooling effect that diverts attention away from the itching. It has also been used as an acaricide in the treatment of scabies, though more effective drugs are usually preferred (1). Crotamiton is also used as solubilizer and may be included in topical NSAIDs, antimycotics, corticosteroids and others (5).
Crotamiton
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Crotamiton has been used in the treatment of mite infestations other than S. scabiei infestation. A case of otoacariasis caused by a histiostomatid mite was successfully treated with crotamiton ear drops for 1 week (Al-Arfaj et al., 2007).
Effectiveness of benzyl benzoate treatment on clinical symptoms and Demodex density over time in patients with rosacea and demodicosis: a real life retrospective follow-up study comparing low- and high-dose regimens
Published in Journal of Dermatological Treatment, 2022
Fabienne M. N. Forton, Viviane De Maertelaer
In 1998, in a small pilot randomized study, we demonstrated the acaricidal action of benzyl benzoate (BB), and to a lesser extent of crotamiton, on D. folliculorum (27). BB and crotamiton are acaricides used in the treatment of scabies mite infestation. BB is relatively nontoxic but may irritate the skin and eyes, can give rise to contact dermatitis and, when ingested, may cause stimulation of the central nervous system and convulsions (28). These treatments have been poorly studied in rosacea and demodicosis (24,25), but, until 2014 when ivermectin became available, we treated nearly all our patients with rosacea with papulopustules or demodicosis with a topical cream composed of these two molecules.
‘Loss of efficacy of topical 5% permethrin for treating scabies: an Austrian single-center study’
Published in Journal of Dermatological Treatment, 2022
Damian Meyersburg, Andreas Kaiser, Johann Wolfgang Bauer
An Iranian study in 2013 comparing the efficacy of permethrin 5% vs. crotamiton 10% in 350 patients reported a cure rate of 70% at the 2-week follow-up (two applications one week apart) and 85% at the 4-week follow-up (after 4 applications) in favor of permethrin 5% cream [6]. A second Iranian study in the same year proved the superiority of two applications of 5% permethrin cream with a one-week interval (97%) over two doses of oral ivermectin given 2 weeks apart (93%) in 68 patients [6]. Both studies were designed for self-application of the cream.
Spinosad topical suspension (0.9%): a new topical treatment for scabies
Published in Expert Review of Anti-infective Therapy, 2022
Deepani D Fernando, Katja Fischer
All currently used scabicides have limitations and none of them are suitable to use across the entire range of patient categories. Benzyl benzoate is known for its immediate skin irritation and is considered unsafe in infants due to systemic absorption [14]. It shows low acute toxicity in laboratory animals with the oral LD50 value for rats being greater than 1 g kg−1. As per British National Formulary, it should be applied to the whole body and repeated the following day [23]. A third application may be required in some cases. Skin and eye irritation and a severe burning sensation in sensitive individuals are seen in approximately 25% of patients. If applied too frequently, too much or to a large area, or if applied to damaged skin this drug’s absorbance is increased [24]. As scabetic skin is by default damaged, due to mite activity and scratching, and with ‘head to toe’ application being recommended, benzyl benzoate treatment can induce signs of toxicity, including blistering, hives, and serious allergic reaction. Hence, benzyl benzoate is not routinely prescribed and for adult use only. For crotamiton, frequent treatment failures have been reported and this therapeutic is not US FDA approved to use in children [14]. Sulfur is unpleasant to use and has suboptimal efficacies [14]. Malathion has high adverse reactions [12]. Lindane is neurotoxic, and hence not suitable to use in pregnant and breast feeding women, infants, children, elderly and patients with neurological disorders [14,25]. Ivermectin is the only drug available for oral treatment of human scabies, mostly used for severe, crusted scabies, mass administration in endemic areas, or institutional outbreaks [4,26–28]. Ivermectin has been proposed to have limited ovicidal activity which has been recently confirmed by in vitro testing [29]. Noting that two days after oral intake of the recommended ivermectin dose the maximum concentration measured in porcine skin is ~60ng/g, a repeat treatment is imperative to kill new larvae, which hatch from eggs within 3 days [14,30]. Although recent research indicates the safety of ivermectin in children <15 kg, the drug is not yet approved in all countries [31,32]. In addition, the safety of ivermectin in pregnant women has not been established. Ivermectin is contra-indicated in young children under 15 kg of body weight, in pregnant or lactating women or in patients with liver or kidney disease [33]. Permethrin treatment is considered a safer choice for use in children over 2 months old, however it is often ineffective when treating severe scabies, is not recommended for use in infants and parasite resistance is emerging [14,34–36]. For example, since permethrin was introduced in Australia about 20 years ago, there has been a definite decrease in mite sensitivity to this compound [34,36,37].