Abstract
Scabies is a common skin infestation with a high prevalence in populations with low socioeconomic conditions. The topical application of benzyl benzoate (BB) is effective due to its neurotoxic effects on mites; however, its efficacy remains inconsistent and ambiguous across studies. In contrast, topical permethrin 5% has emerged as one of the most widely prescribed treatments for scabies, attributed to its relatively high efficacy. Recently, several studies have evaluated the effectiveness of topical permethrin, highlighting the need for a comprehensive synthesis of evidence. Therefore, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of topical permethrin compared to BB in treating scabies. A systematic search of Scopus, PubMed, Web of Science (WOS), and Cochrane Central was performed from inception until January 2025 to identify RCTs comparing the effectiveness of topical permethrin and BB. The primary outcomes were clinical cure rates of scabies lesions and pruritus. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model for dichotomous data. All statistical analyses were conducted using STATA 18MP (StataCorp LLC, College Station, USA). A total of seven RCTs, including 783 patients, met the inclusion criteria. Topical permethrin demonstrated significantly higher clinical cure rates for both scabies lesions and pruritus in the first week of treatment, with improvements of 30% and 23%, respectively (RR = 1.30; 95% CI: 1.11-1.53; p < 0.001 for scabies lesions, and RR = 1.23; 95% CI: 1.04-1.47; p = 0.02 for pruritus), compared to BB. However, no significant differences were observed between the two treatments in subsequent follow-up assessments. In conclusion, topical permethrin provides a superior and faster improvement in the treatment of scabies compared to BB within the first week of therapy, with no significant difference in later assessment durations, highlighting the superiority of permethrin is time-dependent. Further high-quality RCTs with long-term follow-up are warranted to confirm these findings and evaluate sustained efficacy.