Successful combination therapy of permethrin 5% cream and oral ivermectin in crusted scabies patient

Introduction: Crusted scabies, a severe form of Sarcoptes scabiei infestation, is characterized by generalized crusting and scaling, accompanied with hyperkeratotic nails. This case report aims to describe a successful treatment using a combination of permethrin 5% cream and oral ivermectin in crusted scabies patient.
Case: A 55-year-old woman presented with thick scales on her scalp and thickened fingernails and toenails for 3 months. At the onset, she had experienced itching, followed by the emergence of red rashes across her body for a period of 1 year. She was also diagnosed with rheumatoid arthritis and secondary adrenal insufficiency. Upon examination, her dermatological status revealed diffused erythematous papules and patches, partially covered with crusts and excoriations. Additionally, thick white scales and crusts were seen on her scalp and subungual hyperkeratosis was observed in both of her fingernails and toenails. Scraping examination revealed the presence of a large numbers of mites, eggs, and scybala. She was treated with permethrin 5% cream for 7 consecutive days and oral ivermectin 200 mcg/kgBW for a total of 5 doses (administered on days 1,2,8,9, and 15). On day 15, follow-up examination showed improvement in the skin lesions, and the scraping examination yielded negative results.
Discussion: Crusted scabies is a rare variant of scabies. The use of permethrin 5% cream, which is the most commonly used topical agent, in combination with ivermectin, an anthelmintic agent with antiparasitic properties, is recommended in numerous literature sources for the management of crusted scabies.
Conclusion: The combination therapy of permethrin and ivermectin, despite yielding excellent results in crusted scabies patients, is rarely utilized and reported in Indonesia. Therefore, this case report is expected to provide valuable insights into the management of crusted scabies in Indonesia and encourage further research in this area.