Several types of treatment have been conducted since scabies first, but research on the ideal therapy scabies still do. According to Rikyanto (2001), the ideal skabisid is: 1. Should be effective against all stages of mites; 2. Should not cause irritation, hypersensitivity, and non-toxic; 3. No smelly or dirty, and no damage or color of clothing; 4. Easy to obtain and use (can be used by all ages), and also economical.
1. Sulfur presipitatum
This is a drug dosage longest antiskabies used. Celsus uses sulfur mixed in a special fluid for the treatment of early scabies in 25 AD Sulfur ointment is used in the preparation (2% - 10%) and is usually recommended to use ointment recommended 6%. It's easy: after a shower, sulfur ointment applied to the skin evenly throughout the body for two or three days - helped (Karthikeyan, 2005).
Sulfur ointment messy, rank, leaving marks on clothes, as well as in the situation is hot and humid, can stimulate the occurrence of irritant contact dermatitis. And the benefits of this preparation because it is cheap and is a major option in place - a place that requires treatment in a large scabies or economic reasons. Sulfur is recommended as an alternative therapy is relatively safe scabies in infants, children - children, and pregnant women.
2. Benzyl benzoate
Benzyl benzoate is a derivative of benzoic acid and benzyl alcohol are found in Peru and balsam of Tolu. These preparations are neurotoksik on mites. Dosage used in the form of emulsion concentration of 25% with 24-hour contact time without interspersed bath. In younger patients or in children - children, the dose can be reduced to 12.5%. Benzyl benzoate is very effective when used appropriately. Benzyl benzoate can cause irritant contact dermatitis on the face and scrotum. And the repeated use - dematitis repeated contact may cause allergies. Prohibited use of this preparation in pregnant and lactating women, infants and children less than 2 years. In developing countries with limited resources, benzyl benzoate can be used as an economical alternative in the treatment of scabies (Karthikeyan, 2005).
3. Krotamiton
Krotamiton (crotonyl-N-ethyl-o-toluidine) is used in the preparation or lotion kren 10%. Average - the average treatment success with krotamiton between 50% - 70%. Obtained best results when used twice daily for five days - joined after a bath and change clothes. This medication is not recommended in children - children. And its use in pregnant women who do not have enough information (Category C) (Karthikeyan, 2005).
4. Gamma benzene heksakloride (Lindane)
Gamma benzene hekaskloride is an insecticide. Wooldridge was first used to treat scabies in 1948. These drugs work on the CNS (central nervous system) mites and cause an increase eksitabilitas, convulsions, and death. Lindane 1% cream in the form of an effective dosage in the treatment skabies. Applied to use with dry skin and after 6 hours washed with soap, then be repeated again 1 week later.
Lindane became famous for not irritating and easy to use. But the side effects of this drug can not be excluded. On the use of excess (repetitive use - again and laundering more than 6 hours) can cause increased absorption of the drug, as well as use in neonates and infants as well as use in conjunction with the use of hair oil. This resulted in toxicity that causes such symptoms in the CNS, headache, dizziness, nausea, termor, disorientation, muscle weakness, convulsions, breathing failure, even death. Some who had reportedly also be abnormalities in the blood, such as AZ anemia, thrombocytopenia, and pansitopeni (Karthikeyan, 2005). Because the resulting side effects, so that this group can become the drug of choice in the second or third scabies treatment.
5. Permethrin
Permethrin is a synthetic of pirethoid and potent insecticide. Permethrin is very effective against mites with a low toxic effect on mammals. These drugs work by disrupting the exchange of Na + that regulate nerve cell membrane polarization mites. So that will happen inhibition of repolarisasi and resulting in paralysis of the nerve cells mites (Rikyanto, 2001). Permethrin is absorbed in small quantities only through the cutaneous layer, rapidly metabolized by enzymes in the skin, and is excreted through the urine. 5% permethrin cream in the preparation, applied to the entire body once a week for 2 weeks. Left pengolesannya effective in 8 to 12 hours, then washed to clean. This drug is the latest and most effective for the treatment skabies, so that the drug of choice. Permethrin is safe to use on infants over 2 months and in nursing mothers. According to Karthikeyan (2005), from several studies indicate that permethrin has a high cure rates than lindane and krotamiton. Permethrin did not cause side effects of allergies, and in cosmetics can be accepted. Mild burning sensation or smell may arise dreadful, sometimes also causes skin redness, and itching, but it was only temporary (Cordoro, 2008). And the factors that limit the use of this drug, that the price in terms of permethrin is the most expensive compared to other topical medications scabies.
6. Ivermectin
Ivermectin, a derivative of avermectin B, is almost equal to the macrolides, but without the antimicrobial action. How it works through the suppression of nerve impulse conduction in nerve-muscle synapse in the mites with stimulation of gamma amino butyric acid (GABA) from nerve endings and presinaps bind to receptors on postsinaps. Preparations ivermectin in capsule form at a dose of 3 mg or 6 mg. Feeding at a dose of 0.2 mg / kg single dose. When are repeated, preferably 7 - 14 days after the first delivery. The effectiveness of these drugs quite well with good healing and reduced the former - former pruritus. The drug is rapidly absorbed, metabolized in the liver and excreted through feces. Absorption can be improved if ivermectin eaten with fatty foods (Chosidow, 2006). Ivermectin is safe with side effects of a single dose was not significant. According to research conducted Meinking, et al (1995), giving a single dose of ivermectin is effective in treating patients who skabies on "healthy" and in some patients with HIV infection. Giving dikontrandikasikan in patients ivermectin sensitive and allergic to these drugs, patients with CNS disorders. Also this drug is not indicated in pregnant and lactating women, children under 5 years old or weighing less than 15 kg.
Ivermectin therapeutic potential of scabies choice. To further topical ivermectin began to be used in the skabies therapy.
In patients skabies krustosa and also patients with HIV, treatment is needed for a long time. Giving peroral sufficient ivermectin to treat scabies effective, but require multiple doses and in combination with the drug and can be added topical to keratolitik existing hiperkeratosis (Karthikeyan, 2005).
Some problems that can arise in therapy. According to Karthikeyan (2005), among other problems that remain itch feels post-therapy, and treatment failure. Persistent itch can be reduced by giving antihistamines or topical steroids delivery / oral (Cordoro, 2008). And treatment failure can occur because of: providing an inappropriate, inadequate provision, reinfestasi, and reinfection.
Prognosis
With proper diagnosis and appropriate treatment and adequate, the prognosis of recovery from scabies infection quite well. In imunokompromise patients can increase the risk of scabies krustosa, where it will affect the prognosis.
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