A Comparative Study of Treatment Outcomes: Permethrin 5% VS Benzyl Benzoate 25% in Patients with Scabies

Abstract

Objective: To compare treatment outcomes, symptom improvement, and tolerability of topical permethrin 5% versus benzyl benzoate 25% in adults with classic scabies. 

Study Design: Randomized comparative study 
Place and Duration of Study: This study was conducted at the Dermatology unit, Lady Reading Hospital (LRH), Peshawar, Pakistan, from January 1 to December 31, 2024. 

Methods: Adults (≥18 years) with classic scabies were enrolled through consecutive sampling and randomized 1:1 to permethrin 5% (n=63) or benzyl benzoate 25% (n=63). The primary outcome was clinical cure at Day 14 (absence of new lesions with clear clinical improvement). Secondary outcomes included pruritus severity (VAS 010), adverse effects, adherence, and recurrence/reinfestation by Day 28.  

Results: Of 152 screened patients, 126 were randomized. Day-14 follow-up was completed for 60 (permethrin) and 58 (benzyl benzoate). Clinical cure at Day 14 was higher with permethrin than benzyl benzoate (52/63, 82.5% vs 41/63, 65.1%; p=0.026; RR≈1.27). Baseline pruritus VAS was similar (8.1±1.3 vs 8.0±1.4; p=0.679), while scores were lower with permethrin at Day 7 (3.6±1.8 vs 4.4±2.0; p=0.020) and Day 14 (2.1±1.6 vs 3.0±1.9; p=0.005). Burning/irritation was more frequent with benzyl benzoate (33.3% vs 14.3%; p=0.012).  

Conclusion: Permethrin 5% achieved higher Day-14 cure rates, faster pruritus improvement, and better tolerability than benzyl benzoate 25% in adults with classic scabies.