SYSTEMATIC REVIEW article
Front. Med.
Sec. Dermatology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1703912
Efficacy and Safety of Oral Ivermectin versus Benzyl Benzoate for the Treatment of Scabies: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Provisionally accepted
Ahmed Abu-Zaid1*
Hoor Ahmad AlBdah2Latifa AlKandari2Retaj S Aljuma3Shaikha TH Alhussaini4Hawraa Yaqoub Alqallaf2Fai M Alsaleeli2Rashed Ahmed Soud Alhusaini3Danah S Alrasheedi4Jumanah Abdulrahman Alshammari2
Ali Ashkanani3Abdullah M Alharran3- 1College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- 2Kuwait Institute for Medical Specializations, Kuwait City, Kuwait
- 3Arabian Gulf University, Manama, Bahrain
- 4Ministry of Health, Kuwait City, Kuwait
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Background/Objectives: Oral ivermectin and topical benzyl benzoate are two common treatment options for scabies, but there is ongoing discussion regarding their relative safety and efficacy. A thorough synthesis of the available evidence is required to inform treatment decisions because of the clinical debate caused by the contradictory findings from current randomized controlled trials (RCTs). Methods: A systematic review and meta-analysis were conducted on evidence retrieved from PubMed, Scopus, Web of Science, and CENTRAL for RCTs up to August 2025. The primary outcome was the cure rate. Secondary outcomes included pruritus improvement and the incidence of adverse events. Stata MP v. 18 was used to pool outcomes. Results: Ten RCTs involving 1,105 patients were included. Cure rates showed no significant difference between ivermectin and benzyl benzoate at 1 week (RR: 1.07, 95% CI [0.88, 1.30], p = 0.51), 2–4 weeks (RR: 0.99, 95% CI [0.88, 1.12], p = 0.91), or after more than 4 weeks (RR: 1.16, 95% CI [0.95, 1.43], p = 0.15). The overall pooled result confirmed no difference (RR: 1.04, 95% CI [0.95, 1.14], p = 0.37). For pruritus, no significant differences were observed at 1 week (RR: 1.07, 95% CI [0.80, 1.43], p = 0.66), 2–4 weeks (RR: 1.19, 95% CI [0.97, 1.46], p = 0.09), or beyond 4 weeks (RR: 1.10, 95% CI [0.89, 1.37], p = 0.38); overall RR: 1.13, 95% CI [0.99, 1.29], p = 0.07. Ivermectin showed significantly fewer adverse events (RR: 0.27, 95% CI [0.16, 0.46], p < 0.001), especially less burning/stinging (RR: 0.07, 95% CI [0.02, 0.20], p < 0.001). GI events were not significantly different (RR: 1.47, 95% CI [0.67, 3.22], p = 0.34). Conclusion: Oral ivermectin and topical benzyl benzoate exhibit comparable efficacy for the treatment of scabies. However, ivermectin's significantly better safety and
Keywords: itch, Scabies, Ivermectin, Benzyl benzoate, Meta-analysis
Received: 12 Sep 2025; Accepted: 20 Oct 2025.
Copyright: © 2025 Abu-Zaid, AlBdah, AlKandari, Aljuma, Alhussaini, Alqallaf, Alsaleeli, Alhusaini, Alrasheedi, Alshammari, Ashkanani and Alharran. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ahmed Abu-Zaid, aabuzaidstjude@gmail.com
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