The Efficacy, Safety and Tolerability of Sulfur in the Treatment of Scabies: A Cross-Sectional Study

Objective: The incidence of scabies has been increasing. The emergence of cases non-responsive to permethrin has urged the need for alternative treatments. Although sulfur has been considered an option for scabies treatment, there has been no conclusive data on this topic. The study was conducted to determine the efficacy and safety of sulfur in scabies. Material and Methods: All scabies patients treated with topical sulfur from January 2020 to February 2022 were included in the study. Procedurally, 5-10% sulfur was applied on three consecutive days and washed off every 24 hours (the duration varied depending on the patient-related factors or clinician's experience). The treatment was repeated if there was no cure at control. Results: There were 64 (39 female) patients. After 3-day treatment, 72% were cured. The overall cure rate was 92%. The median duration of therapy was three days (2-30). The length of treatment was correlated with the duration of pruritus before diagnosis and was longer in patients with widespread lesions. The side effects were more severe in those with extended lesions and those with more prolonged treatment. Conclusion: The present study demonstrates that sulfur is effective in majority of the patients after 3-day treatment. Most patients had no or minimal side effects. As the side effects increase with the length of treatment, the additional application should be reserved for those who are not cured at the control visit. Particular attention should be given to patients with widespread lesions since they require prolonged treatment and have an increased risk of side effects.