Oral Albendazole as an Alternative Treatment for Moderate Crusted Scabies Along with 5% Permethrin and 5% Salicylic Acid

Abstract

Crusted scabies (CS) is a severe variant of scabies, highly contagious, caused by numerous Sarcoptes scabiei (S. scabiei) infestation. CS is associated with immunosuppressive conditions, like systemic lupus erythematosus (SLE). Various topical and oral scabicidals are used in the treatment of CS, including topical sulfur compounds, benzyl benzoate, crotamiton, lindane, malathion, permethrin, and ivermectin. The treatment of CS does not only need scabicidals, but also keratolytic agents to remove the thick crusts. The severity of CS is classified into three levels and related to the dose of oral ivermectin treatment. When oral ivermectin is not available, oral albendazole can be used as an alternative treatment. A case of CS in a 21-year-old girl with SLE was reported. Physical examination showed multiple lesions in the form erythematous papules, plaques, scales, and hyperkeratotic crusts in almost all parts of the body. The distribution of crusting >30% body surface area, the depth of crusting >10 mm, and there were pyoderma. Sarcoptes scabiei, eggs, and scybala were found on skin scraping. The patient was diagnosed as a moderate CS and treated with occlusive dressings using 5% salicylic acid in vaseline until crusts fell off, 5% permethrin cream three times per week, and 800 mg/day albendazole three consecutive days per week. A clinical and microscopic cure was achieved at day 19 of observation. Albendazole is an antiprotozoal agent with larvicidal effect, therefore it can be used as an alternative treatment of CS when oral ivermectin is unavailable, along with 5% permethrin and 5% salicylic acid.