Combined Oral Ivermectin and 5% Permethrin Cream to Treat Severe Scabies
In brief
Higher-dose ivermectin plus permethrin cured 75% of severe scabies cases, versus 82% with standard dose
In a randomized trial of 132 adults with severe scabies, cure rates were 75% with higher-dose ivermectin and 82% with standard-dose ivermectin, both combined with 5% permethrin cream. No safety issues were identified, but the higher dose was not superior; the results do not establish whether the regimens are equivalent.
- Journal
- New England Journal of Medicine (Q1)
- Published
- 7 May 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Charlotte Bernigaud, Giao Do-Pham, Elie Guichard, Marie Beylot-Barry, Elisa Goujon, Camille Isnard, et al.
- PMID
- 42090793
- DOI
- 10.1056/NEJMoa2411721
Why clinicians should know about it
- Picked for Dermatology (top studies of the week, 18 October 2026): Randomized trial of high‑dose ivermectin plus permethrin for severe scabies
Abstract
BACKGROUND: Severe scabies, a rare parasitic skin disease characterized by abundant skin mites, may be life-threatening and poses public health concerns worldwide. A combination of standard-dose oral ivermectin and topical scabicides is recommended for treatment. However, data from randomized clinical trials are lacking, and the probability of cure is uncertain. Ivermectin at higher doses has been effective in the treatment of some parasitic diseases. METHODS: We conducted a blinded randomized trial involving adults with severe scabies (i.e., profuse or crusted), as confirmed by parasitologic or dermoscopic assessment. The patients were assigned in a 1:1 ratio to receive oral ivermectin (to be taken with food) at a dose of 400 μg per kilogram of body weight (higher-dose group) or 200 μg per kilogram (standard-dose group) on days 0, 7, and 14, combined with head-to-toe application of 5% permethrin cream on days 0 and 7 and daily application (as recommended) of an emollient cream. The primary end point was cure of severe scabies, which was defined as the absence of mites and mite-related products (i.e., eggs and feces), as confirmed by parasitologic or dermoscopic assessment on days 18 and 21, and the absence of active clinical lesions on physical examination on day 28. RESULTS: A total of 132 patients (66 in each group) were included in the main analysis. Cure was observed in 75% of the patients in the higher-dose group and in 82% of those in the standard-dose group (odds ratio for cure, 0.64; 95% confidence interval, 0.25 to 1.67). No safety issues were identified. CONCLUSIONS: Among adults, the 400-μg-per-kilogram dose of ivermectin plus 5% permethrin cream was not superior to the standard 200-μg-per-kilogram dose of ivermectin plus 5% permethrin cream in curing severe scabies. (Funded by the French Ministry of Health and French Society of Dermatology; ClinicalTrials.gov number, NCT02841215.).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.