Both permethrin and ivermectin significantly improved pruritus, sleep quality, depression, and dermatology-related quality of life in scabies patients, but permethrin conferred greater short-term psychological benefit, particularly in anxiety reduction and emotional quality of life.
Key Findings
Results
Both permethrin and ivermectin significantly improved VAS pruritus scores, PSQI sleep quality scores, HADS-depression scores, and Skindex-29 scores over the 6-week treatment course.
Within-group improvements were statistically significant for all four measures in both treatment arms (p < 0.001)
600 adults with confirmed scabies were enrolled in a multicenter cohort study conducted between February and August 2025
292 patients received oral ivermectin and 308 received topical permethrin
Patients were evaluated after completing a full 6-week treatment course
No serious adverse events were reported in either treatment group
Results
Anxiety reduction as measured by HADS-anxiety was significantly greater with permethrin than with ivermectin.
The difference in HADS-anxiety reduction between treatments was statistically significant (p < 0.001)
This difference remained significant after adjusting for change in pruritus, suggesting a mechanism beyond symptom control
Between-group analyses were supported by multivariate linear regression, subgroup interactions, ANCOVA, and mediation analysis
The anxiety benefit of permethrin over ivermectin was described as persisting independent of pruritus improvement
Results
Permethrin showed superior outcomes in emotional quality of life as measured by the Skindex-Emotions subscale compared to ivermectin.
The difference in Skindex-Emotions scores between treatment groups was statistically significant (p = 0.022)
Skindex-29 is a dermatology-specific quality of life instrument
Overall Skindex-29 scores improved significantly in both groups (p < 0.001)
The emotional subscale showed differential improvement favoring permethrin beyond the overall quality of life measure
Results
Anxiety reduction with permethrin was not fully mediated by pruritus improvement, suggesting psychobehavioral mechanisms independent of itch relief.
Mediation analysis was conducted to examine the pathway between pruritus change and anxiety outcomes
The HADS-anxiety difference between groups remained significant after adjusting for change in pruritus (p < 0.001)
Authors describe these findings as highlighting 'the relevance of psychobehavioral mechanisms in scabies management beyond symptom control'
This finding implies that the route of administration or other properties of permethrin may contribute to psychological outcomes
Methods
The study population consisted of 600 adults with confirmed scabies treated across multiple centers, with 292 receiving oral ivermectin and 308 receiving topical permethrin.
The study design was a prospective multicenter cohort
Treatment period ran from February to August 2025
All patients completed a full 6-week treatment course before evaluation
Outcome instruments included VAS for pruritus, HADS for anxiety and depression, PSQI for sleep quality, and Skindex-29 for dermatology-related quality of life
Both permethrin and ivermectin are described as 'established first-line therapies' for scabies
What This Means
This research suggests that both of the most commonly used scabies treatments — a topical cream called permethrin and an oral medication called ivermectin — are effective at reducing not just the intense itching of scabies, but also depression and sleep problems that often accompany the infection. The study followed 600 adults over six weeks and measured outcomes using standardized scales for itching, anxiety, depression, sleep, and skin-related quality of life. Both treatments produced significant improvements across all these measures.
However, this research suggests that permethrin provided additional psychological benefits beyond what ivermectin offered, particularly in reducing anxiety and improving emotional quality of life. Importantly, this advantage in anxiety reduction could not be fully explained by the fact that permethrin may have reduced itching more effectively — statistical analyses showed the psychological benefit persisted even after accounting for itch relief. This points to possible psychological or behavioral mechanisms tied to the act of applying a topical treatment, or other properties of permethrin itself.
These findings matter because scabies is a common condition worldwide that can cause significant mental distress, not just physical discomfort. This research suggests that when clinicians choose between these two treatments, psychological well-being — not just symptom control — may be a relevant factor to consider. The authors note that no serious side effects were observed with either treatment, reinforcing that both remain safe options.
Esen M, Demirbas A, Diremsizoglu E, Ulutas Demirbas G. (2026). Comparative effectiveness of permethrin and ivermectin on pruritus and psychological outcomes in scabies: a prospective cohort of 600 adults.. Postgraduate medicine. https://doi.org/10.1080/00325481.2026.2643021