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Svetlana Tarasova
Hairdresser-stylist with more than 8 years of experience, expert in the field of haircuts, styling, hair care, coloring.
Benzyl benzoate is a popular antiparasitic agent that helps fight lice and scabies. When used externally, the medication enters only the upper layers of the skin, without penetrating into the bloodstream. Now doctors rarely prescribe this drug, but, being effective and inexpensive at the same time, it remains popular.
Benzyl benzoate for lice - what is it, its composition and does it help against lice?
The active substance in the antiparasitic drug is benzyl benzoate. There are also additional components that differ depending on the release form. The product has a destructive effect on parasites. Its active component penetrates the chitinous layer of lice and accumulates in their body in concentrations incompatible with life.
Benzyl benzoate helps in the treatment of head lice, helping to destroy all types of parasites. It is capable of destroying both adults and larvae, but does not affect insect eggs.
The composition quickly penetrates the skin and begins to act, destroying parasites. When used topically, it is completely safe as it is not absorbed by the skin and does not penetrate the bloodstream.
REFERENCE. In addition to lice, the drug is effective against almost all mites, including those that cause scabies.
Larvae and adult lice die 2-5 hours after using the drug.
Characteristic
Benzyl benzoate has been known for a long time as a remedy for lice. Over the years of its existence, the drug has proven itself to be highly effective. The medicinal unit is used in the fight against various parasites (lice, skin mites). Thanks to its use, it is possible to get rid of “uninvited guests” in just a few hours (2–5 is enough).
The action of benzyl benzoate is based on toxic poisoning of parasites. The product freely penetrates through the dense chitinous layer that protects the insect. Ingested benzoate accumulates in the body of the louse in extreme concentrations. The result of a strong toxic effect that paralyzes the nervous system is the inevitable death of adult individuals. At the same time, the use of medicinal forms locally has absolutely no effect on human health. Benzene almost does not enter the blood.
The medication is produced in 2 versions: emulsion, ointment. The base of any of them consists of benzoic acid phenylmethyl ester. Additional ingredients of the emulsion are:
- laundry soap (72% concentration);
- cetostearyl alcohol;
- purified water base;
- emulsion wax;
- citric and stearic acids.
The ointment is produced from benzyl benzoate on a water-emulsion basis. The additional inclusion of antimicrobial preservatives (in particular, cetylpyridinium chloride) makes it possible to achieve a bacteriostatic effect.
Release forms and how to use against lice and nits
The drug is available in two forms - emulsion and ointment for external use.
Emulsion
The emulsion is a homogeneous white liquid, packaged in bottles of 50, 100 and 200 ml.
Compound
The active substance in the emulsion is benzyl benzoate. As additional components, it contains purified water, emulsion wax, and laundry soap.
Instructions for use
Antiparasitic emulsion is used as follows:
- You need to shake the bottle well.
- Take a cotton swab and soak it in the emulsion.
- Apply the composition to the scalp and treat clean, dry hair.
- Cover your head with polyethylene and insulate it with a scarf or warm towel.
- Leave the product on your head for half an hour.
- Rinse your hair with acidified water, diluting a tablespoon of vinegar. The acid will help separate the nits from the hair.
- Wrap the head again and leave the acid for about an hour.
- Wash your hair with shampoo.
- Comb out lice and nits with a fine-toothed comb.
To eliminate lice and larvae, it is enough to use the product once. But it does not affect parasite eggs, so repeated treatment may be necessary.
Cost and where to buy
You can purchase the emulsion in pharmacies. It is quite cheap - the cost is about 50 rubles.
Shelf life and storage conditions
The drug must be stored in a dark place at a temperature less than 20 degrees . The shelf life is three years. Opened suspension can be stored for up to one week at room temperature.
Contraindications, possible side effects and safety precautions
The drug has a number of contraindications:
- children under three years of age;
- hypersensitivity to the components of the product;
- pregnancy and lactation;
- pustular skin diseases.
The medication may cause an allergic reaction.
If it gets into the eyes, a strong burning sensation occurs. Often the product provokes irritation of the facial skin. IMPORTANT! If the emulsion gets into the eyes, nose and mouth, they should be thoroughly rinsed with water. If it gets into the stomach, you need to wash it with a 1-2% solution of sodium bicarbonate, a mixture of activated carbon and burnt magnesia.
Ointment
The ointment for external use is white and is sold in aluminum tubes or glass jars.
Compound
The active component in the ointment is similar - benzyl benzoate . The drug also includes propylene glycol, fatty fractions, cetostearyl alcohol, cetylpyridinium chloride, purified water,
Instructions for use
The ointment is applied to clean hair and rubbed into the scalp with gentle movements . If it is used for a child, it must be diluted with warm water in equal proportions. After application, you need to wrap your head in polyethylene and insulate it. The composition remains on the hair for a period of 30 minutes to 2 hours.
ATTENTION! If the ointment burns strongly, it should be washed off immediately.
The medication is first washed off with acidified warm water, then washed thoroughly using shampoo. The hair is then combed out with a fine-tooth comb to remove dead lice and larvae. Benzyl benzoate nits do not die, and they also need to be removed manually.
Cost and where to buy
The ointment can be bought at any pharmacy. Its average price is about 30 rubles.
Shelf life and storage conditions
The ointment has a shelf life of three years. It should be stored in a place protected from light, at a temperature of 18-20 degrees.
Contraindications, possible side effects and safety precautions
The ointment is contraindicated for children under three years of age, pregnant and lactating women, and persons with hypersensitivity to the active component. Also, it cannot be used for mechanical damage and pustular inflammation on the skin.
Side effects include contact dermatitis, redness, burning and itching of the skin.
As in the case of the emulsion, the product must not be allowed to get inside or onto the mucous membranes . If the ointment is used for children under 5 years of age, it must be diluted with water in equal proportions. The water temperature should be no more than 35 degrees. The result should be a mixture of sour cream consistency.
It is recommended to apply the product using rubber gloves. In case of direct contact of the skin of your hands with the drug, you should thoroughly wash them with laundry soap, and also wash and iron all personal items.
Material and methods
Models/standards have been developed for the treatment of patients with scabies complicated by secondary pyoderma, allergic dermatitis, microbial eczema, and LSK [49, 50]. They have been tested in practice in more than 500 patients and are included in the “National Standard. Dermatovenereology" (2011) [34] and "Federal clinical recommendations for the management of patients with scabies", developed under the auspices of the Russian Academy of Medical Sciences [37]. In accordance with the new requirements, the standards include international nonproprietary names of scabicides and levels of evidence (A, B, C, D).
Results of our own research.
When starting to treat a patient with scabies, the doctor must follow the general principles of therapy, regardless of the chosen scabicide and the presence of complications:
— simultaneous treatment of all patients identified in the outbreak to prevent reinvasion;
- rubbing in anti-scabies in the evening to increase the effectiveness of therapy, which is associated with the nocturnal activity of the pathogen;
- rubbing anti-scabies into the entire skin of children under 3 years of age; in other patients, the exception is the face and scalp;
— rubbing scabicides is carried out with bare hands, and not with a napkin or swab; the preparations are especially carefully rubbed into the skin of the palms and soles;
— if after rubbing the drug in, there is a need to wash your hands, then they must be re-treated with scabicide;
— washing before the first application of scabicide and after completion of treatment; change of underwear and bed linen - after the course of therapy;
- exposure of the drug to the skin should be at least 12 hours, including the entire night period; it can be washed off in the morning;
- after completion of therapy, it is necessary to carry out disinsection of underwear and bed linen, towels, clothes and shoes, and wet cleaning of the room where the patient was.
Below are models/standards for the treatment of scabies with LS, complicated by secondary pyoderma, microbial eczema and allergic dermatitis, legally enshrined in the “Federal Clinical Guidelines for the Management of Patients with Scabies” [37] with clinical examples from the personal practice of the authors.
Treatment of SLK
After a full course of treatment of scabies with any scabicide, the mites in the epidermis of the SLK element die, and etiological recovery occurs. However, SCL can persist for up to 6 months [32]. The time for its regression is reduced if, before starting specific therapy, the epidermis is scraped from the surface of the papules with a scalpel until droplets of blood appear. The skin defect is treated with antiseptic drugs (aniline dyes, 5% potassium permanganate solution, povidone-iodine solution, chlorhexidine bigluconate, etc.). Specific treatment with any scabicide (in the evening) is combined with rubbing topical corticosteroids with antibiotics into the papules (morning and afternoon), for example, betamethasone dipropionate with gentamicin sulfate ( Akriderm Genta
).
If, after the resolution of the main clinical manifestations of scabies (vesicular tracts, follicular papules), SLK persists, treatment is continued with single-component TCS under an occlusive dressing. One of the effective drugs is methylprednisolone aceponate with urea ( Comfoderm M
2). Due to the moisturizing effect of urea, methylprednisolone aceponate penetrates into the deep layers of the skin. Phono- or photophoresis can be used with single-component TCS, except in cases where the TCS is localized on the male genitals. An effective method of treating SLK is cryodestruction of lesions followed by application of the combined TCS indicated above.
Case from practice
Patient A
., 29 years old, temporarily unemployed. I contacted a dermatologist at my place of residence with complaints of severe itching, worsening in the evening and at night, the presence of small rashes on the skin of the hands, wrists, thighs and abdomen, as well as large “nodes” on the penis and in the axillary region. She has been sick for about a month. Believes that he became infected through intimate contact. Lives alone in a dormitory. The diagnosis of scabies was confirmed by laboratory tests. Treatment with 20% benzyl benzoate emulsion was prescribed for 3 days. It is recommended to conduct a similar course of therapy for the sexual partner. The patient's condition has improved significantly. The rashes on the hands, wrists, thighs and abdomen became significantly paler and stopped itching. However, the itching persisted in the area of lenticular papules on the penis and in the axillary region and was of a biopsy nature. The doctor assessed this situation as a lack of effect from the specific therapy of benzyl benzoate emulsions. A second course of treatment was prescribed with another scabicide - a 0.4% solution of permethrin prepared from a 5% emulsion concentrate in ethanol (Medifox). The patient rubbed the drug in at night for another 3 days in a row. The doctor categorically forbade the patient to wash off the medicine until the end of the course of therapy. After the second course of therapy, the patient developed widespread erythema on the back and itchy rashes on the buttocks, thighs, and abdomen. The patient independently contacted the department.
Objective examination data
. The process is common. On the penis (Fig. 2, a) and in the right axillary region (see Fig. 2, b) lenticular papules with a diameter of up to 5 mm were detected, one of them with a massive blood crust on the surface. On the skin of the back there is erythema with infiltration and linear scratches (see Fig. 2, c), on the front surface of the thighs there are multiple bright red roseolas (see Fig. 2, a). Numerous bloody crusts and linear scratches were detected in all areas of the skin. Using dermatoscopy, an itch with a dead female mite was found on the palm (see Fig. 2, d).
Rice.
2. Patient A., 29 years old. Scabies with scabious lymphoplasia of the skin on the penis (a) and in the axillary region (b); allergic contact dermatitis resulting from excessive use of benzyl benzoate ointment (c); dermatoscopy of scabies on the palm (d). Diagnosis: persistent scabious lymphoplasia of the skin after specific therapy. Contact drug allergic dermatitis.
Treatment was prescribed: levocetirizine, 1 tablet at night for a course of up to 10 days; rub methylprednisolone aceponate cream with urea ( Comfoderm M)
2) once a day before bed until the rash is completely resolved.
Allergic dermatitis resolved within 7 days, SLK - after 1.5 months.
Mistakes made by a doctor when caring for a patient.
1. In accordance with the “Federal Clinical Guidelines for the Management of Patients with Scabies,” rubbing in an emulsion of benzyl benzoate and medifox is carried out on the 1st and 4th days of the course. The doctor recommended rubbing both scabicides for 3 days in a row.
2. Persistent LSK with a full course of specific therapy and treatment of the sexual partner is not a reason to continue treatment with a scabicide. In this case, it was advisable to re-examine the patient for the presence of a live pathogen before prescribing Medifox.
3. Considering that the patient was receiving a second scabicide, he should not have been prohibited from washing off the drug every morning. To kill the active stages of scabies mite, exposure of the drug to the skin for 8-12 hours is sufficient. Excessive specific therapy contributed to the occurrence of allergic contact dermatitis.
Treatment of scabies complicated by secondary pyoderma
Treatment begins with the application of a scabicide to eliminate itching, which contributes to the disruption of the skin barrier and the introduction of bacterial microflora. Preference is given to scabicides that do not require intensive rubbing, which prevents the spread of infection throughout the skin. This product is in an aerosol package based on esdepalletrin with the addition of piperonyl butoxide (Spregal) and a 0.4% solution of permethrin prepared from a 5% emulsion concentrate in ethanol (Medifox). Scabicides are rubbed in on the 1st and 4th days of the course, while pyoderma is treated on the 2nd and 3rd days. The question of washing the patient before rubbing in the anti-scabies agent is decided by the doctor individually and taking into account the possibility of dissemination of the infection.
For superficial pyoderma (impetigo, ostiofolliculitis, tourniol, etc.), only external therapy is used. Pustules are extinguished with solutions of aniline dyes, 5% potassium permanganate solution, povidone-iodine solution and other antiseptic drugs. If impetigo is present, its cover is pierced with a sterile needle. After the pustules dry into crusts, ointments/creams with antibacterial drugs are prescribed: bacitracin with neomycin, mupirocin, fusidic acid, levomekol. You can use ointments/creams with universal antiseptic drugs: povidone-iodine, silver sulfathiazole (argosulfan, etc.). In case of severe inflammation around purulent crusts, TCS with antibiotics is indicated: betamethasone dipropionate with gentamicin sulfate ( Akriderm Genta
), hydrocortisone acetate with oxytetracycline hydrochloride and others, as well as combined TCS with acids: betamethasone dipropionate with salicylic acid (
Akriderm SK
), hydrocortisone acetate with fusidic acid and others.
For deep forms of pyoderma (ecthyma vulgaris, deep folliculitis, boils), treatment is supplemented by the prescription of systemic broad-spectrum antibiotics. When choosing topical medications, preference is given to combined TCS in combination with antibacterial agents, for example, betamethasone dipropionate cream/ointment with gentamicin sulfate ( Akriderm Genta
).
Case from practice
Patient G
., 26 years old, lawyer, lives alone. He independently contacted the department with complaints of multiple rashes on the skin of the buttocks. Ill for 3 months. Initially, itching appeared, intensifying in the evening, and some kind of rash on the skin of the arms, abdomen and thighs. On the advice of a physician friend, I rubbed benzyl benzoate ointment into the affected areas for 2 days in a row. There has been an improvement. The itching became less intense, the rashes on the above mentioned areas of the skin became paler. After 2 weeks, the process resumed, with the buttocks and thighs becoming the main location of the rash. The painful itching led to severe scratching of the skin and the appearance of pustules. I contacted a dermatologist at my place of residence. A diagnosis of “Scabies complicated by secondary pyoderma” was made and a recommendation was given to initially treat pyoderma. Povidone-iodine was prescribed for lubricating pustules and erosions 2 times a day, and bacitracin ointment with neomycin was prescribed for application to the lesions at night. The lack of effect in treatment forced the patient to contact the department.
Objective examination data
. The process is common. On the buttocks and in the intergluteal fold there are various types of pustules - staphylococcal impetigo, folliculitis, small-sized ecthyma vulgaris (Fig. 3, a). On the lower surface of the buttocks there is SLK with large bloody crusts on the surface. Dermoscopy revealed 16 itch burrows on the hands (see Fig. 3, b), 2 burrows on the wrists, and 3 burrows on the feet (see Fig. 3, c). Multiple “pearly” vesicles up to 2 mm in diameter were found on the lateral surfaces of the fingers, and follicular papules were found on the anterior surface of the body. Bloody crusts and scratches are disseminated throughout the skin. Positive symptoms of Gorchakov and Michaelis were revealed. The causative agent of scabies was detected by bacterioscopic and dermatoscopy methods.
Rice.
3. Scabies complicated by secondary pyoderma: staphylococcal impetigo, folliculitis, ecthyma vulgaris, scabious lymphoplasia of the skin on the buttocks (a); scabies on the palm (b); scabies on the foot (c). Final diagnosis: scabies complicated by secondary pyoderma (staphylococcal impetigo, folliculitis, ecthyma vulgaris), LS.
Treatment prescribed; 0.4% permethrin solution prepared from 5% emulsion concentrate in ethanol (Medifox). It is recommended to rub the scabicide overnight on the 1st and 4th day of the course, lubricate pustules and erosions in the morning and at lunch with a povidone-iodine solution. On the 2nd, 3rd, 5th and subsequent days, intensive treatment of secondary pyoderma was carried out. Since it occurred with severe inflammation of the skin, betamethasone dipropionate cream with gentamicin sulfate was prescribed ( Akriderm Genta
) at night, povidone-iodine - in the morning.
Akriderm Genta
was rubbed into the crusts (until they were completely rejected) and into the lesions of LSK (until they were completely resolved) 2 times a day.
Dynamics of the process. Resolution of vesicles, follicular papules, staphylococcal impetigo was registered on the 6th day from the start of therapy, folliculitis - on the 10th day, vulgar ecthyma - on the 14th day, SLK - after 3 weeks. The patient is recommended to simultaneously treat his sexual partner to avoid reinvasion.
Mistakes made by doctors when caring for a patient.
1. The therapist made two serious mistakes when giving advice to a patient on treating scabies with a scabicide. It was necessary to treat the entire skin except the head and neck with benzyl benzoate ointment. The frequency of prescription of the drug is incorrectly indicated. Benzyl benzoate ointment is rubbed in on the 1st and 4th days of the course, since it has been experimentally proven that drug-resistant larvae in egg membranes hatch from eggs on the 4th day. It is possible that a violation of the treatment regimen led to a relapse of the disease.
2. The dermatologist’s mistake was that scabies and pyoderma should be treated simultaneously: the scabicide should be applied at night, and the antibacterial agent should be applied in the morning and at lunchtime. Considering the pronounced inflammation and the presence of SLK, it is better to use combined TCS with an antibiotic instead of single-component topical antibacterial drugs. In our case, it was betamethasone dipropionate with gentamicin sulfate ( Akriderm Genta
)
Treatment of scabies complicated by allergic dermatitis
Treatment of scabies complicated by allergic dermatitis begins with rubbing in a scabicide to eliminate the activity of the scabies mite, which produces allergens: feces, oral secretions that pour out when gnawing a burrow, and the sticky secretion of the oviduct glands, which serves to stick eggs to the walls of the burrow. Preference is given to scabicides that do not require intense rubbing (an aerosol product based on esdepalletrin with the addition of piperonyl butoxide and a 0.4% permethrin solution prepared from a 5% emulsion concentrate in ethanol). The scabicide is rubbed in on the 1st and 4th days of the course, and on the 2nd and 3rd days allergic dermatitis is treated. With a limited process, only local therapy is advisable. For this purpose, combined TCS are used, for example betamethasone dipropionate with gentamicin ( Akriderm Genta
). The first component of the drug eliminates itching and inflammation, the second prevents the possibility of infection of skin defects that arise as a result of scratching during itching.
For widespread allergic dermatitis, antihistamines are prescribed orally (levocetirizine, chloropyramine hydrochloride, clemastine, cetirizine, desloratadine, etc.). The use of TCS is limited, since most of them are applied to a skin area not exceeding 14-20% to prevent systemic effects. The drug of choice in this case is methylprednisolone aceponate with urea ( Comfoderm M
2), which can be used on the affected area up to 60%.
You can also use a shaken water mixture (mash), cindol, and care products for dry, irritated skin. After the transformation of the widespread process into local treatment, you can continue with combined TCS, in particular betamethasone dipropionate with gentamicin ( Akriderm Genta
).
Case from practice
Patient G
., 44 years old, military man. I contacted the department on 04/04/16. I got sick 1.5 months ago. The first rashes appeared on the scrotum and in the penis area. I lubricated them with mometasone furoate (elok) myself. The itching on the genitals decreased, but multiple small itchy rashes appeared on the body (back, sides of the chest, abdomen). I went to a private clinic. The doctor examined only the areas of the skin indicated by the patient. He diagnosed: allergic dermatitis, prescribed desloratodine 1 tablet orally at night, and cindol externally. The patient's condition continued to deteriorate. The process spread to the body. Itching and scratching led to redness of the skin. Small bubbles appeared on the brushes.
The patient, on the recommendation of a friend, sought advice from the department. In addition to the medical history, it was established that he and his wife were divorced. Lives alone, has a permanent sexual partner. The woman allegedly suffers from an allergic disease caused by detergents. Her examination revealed clinical manifestations of scabies: 14 scabies on the hands and wrists, multiple follicular papules on the abdomen, buttocks, thighs, non-inflammatory vesicles on the hands and feet, positive Gorchakov and Michaelis symptoms.
Data from an objective examination of the patient
. The process is widespread. The rashes are disseminated over almost the entire skin with the exception of the head and neck. First of all, attention was drawn to erythema with a small papular rash on the back (Fig. 4, a), on the lateral surface of the body with transition to the stomach (see Fig. 4, b), focal papules with a diameter of up to 2 mm on the buttocks (see Fig. 4, a), thighs, upper limbs, many linear scratches and bloody crusts. Using dermatoscopy, 12 itch tracts were identified on the hands (see Fig. 4, c), on the wrists - 2, on the feet - 1. In the interdigital folds of the hands, on the lateral surfaces of the fingers and hands, many “pearly” vesicles were found (without signs of inflammation) , in the scrotum area - severely itchy lenticular papules, on the penis - 2. Positive symptoms of Gorchakov and Michaelis were noted.
Rice.
4. Patient G., 44 years old. Scabies complicated by allergic contact dermatitis: a common process in the form of erythema with a small papular rash on the back (a), on the side surface of the body with transition to the stomach (b), focal papules with a diameter of up to 2 mm on the buttocks (a), intact scabies tract in I interdigital fold of the right hand (c). Final diagnosis (laboratory confirmed): scabies complicated by allergic contact dermatitis, LS.
Treatment was prescribed: 0.4% permethrin solution prepared from a 5% emulsion concentrate in ethanol (Medifox). It is recommended to rub the scabicide on the 1st and 4th day of the course at night. For the treatment of widespread allergic dermatitis, the antihistamine drug levocyterizine was prescribed, 1 tablet at night for a course of up to 14 days. On the 1st and 4th days of the course, rubbing methylprednisolone aceponate with urea ( Comfoderm M
2) in the morning, and on the 2nd and 3rd, 5th and subsequent days - 1 time before bed until allergic dermatitis and LSK are completely resolved. The sexual partner was prescribed a similar specific treatment with Medifox.
Process dynamics
. Resolution of the clinical manifestations of scabies, complicated by allergic dermatitis, occurred 2 weeks after the start of specific and nonspecific therapy. SLK persisted for a long time and resolved after 6 weeks.
Mistakes made by a doctor when caring for a patient.
1. The patient had a poorly collected history of the disease, the entire skin was not examined, and the epidemiological history was not studied, as a result of which a woman was not identified, contact with whom could support reinfestation.
2. The external use of single-component TCS mometasone furoate (Elocom) is prescribed for a large area of skin, which is contraindicated due to the possibility of developing systemic complications.
3. Simultaneous administration of the antihistamine drug desloratodine and topical mometasone furoate helped relieve itching, but did not eliminate the main cause of the disease. The population of mites in the patient's skin continued to increase. Scratching the skin contributed to the development of allergic dermatitis, which was caused by a biological agent - the scabies mite Sarcoptes scabiei
.
Treatment of scabies complicated by microbial eczema
Microbial eczema is often confined to places where SCL is localized. In this regard, her treatment for scabies includes three stages.
1. Treatment of scabies with one of the scabicides according to the generally accepted method.
2. Treatment of microbial eczema, the resolution of which is often accompanied by the appearance in its place of intensely itchy lenticular papules of LSK, often multiple.
3. Treatment of SLK according to the method indicated above.
Microbial eczema with scabies is usually localized on the buttocks and abdomen. The process is usually limited. Treatment tactics include prescribing oral antihistamines (levocetirizine, chloropyramine hydrochloride, clemastine, cetirizine, desloratadine, etc.). Among external agents, preference should be given to three-component combined TCS containing an antibiotic and an antimycotic. This is due to the fact that the allergenic effect of Staphylococcus aureus
significantly increases under conditions of mixed infection with
C andida albicans,
which belongs to the opportunistic microflora, which often colonizes the intestines, mucous membranes of the genitals and oral cavity [51].
It cannot be excluded that it may be brought into the area of microbial eczema foci in the indicated localizations of the process. Akriderm GK
) in 12 patients in this case
As an example, we give a rare case of localization of microbial eczema in the elbow area due to scabies.
Patient R
., 61 years old, retired. He is registered with a urologist for prostate adenoma, and with an endocrinologist for diabetes mellitus. The patient is constantly bothered by itchy skin. Consulted with a dermatologist a year ago. A diagnosis of secondary symptomatic skin itching was made. Treatment was prescribed: rubbing the skin with a 3% solution of acetic acid and cindol. Two months ago, the clinical picture of the disease changed: severe itching appeared, worsening in the evening. Three “nodes” appeared on the skin of the right elbow, and small “pimples” appeared on the skin of the torso. Scratching the elbow resulted in the appearance of a continuous lesion covered with multiple crusts. I contacted a dermatologist at my place of residence. A diagnosis was made: microbial eczema. Treatment was prescribed: oral antibiotic amoxicillin with clavulanic acid (amoxiclav) 500 thousand units 2 times a day for a course of 5 days; clemastine (tavegil) 1 tablet at night; Externally, hydrocortisone acetate ointment with oxytetracycline (hyoxysone) 2 times a day on the lesion in the elbow area and cindol on other areas of the skin. There was no effect from the treatment, and the patient, on the advice of a neighbor, turned to the department for advice.
In addition to the medical history, it was established that 3 weeks before the activation of the skin process, the patient was visiting his daughter for several days. I slept in the same bed with my 6-year-old grandson, who, according to his mother, developed a skin rash 3 weeks ago. The dermatologist diagnosed childhood pruritus and prescribed appropriate treatment. It later turned out that the boy had scabies. The whole family was treated.
From the medical history it was established that the pustules in the area of the lesion on the elbow appeared after the appearance of nodes and their scratching, and then weeping appeared.
Data from an objective examination of the patient
. The process was widespread. The rashes were localized on the skin of the hands, wrists, feet, shoulders, forearms, abdomen, thighs, and buttocks. First of all, attention was drawn to the lesion on the right elbow, the size of the palm of an adult (Fig. 5, a). The lesion is represented by red infiltration with a purple tint, clear boundaries and a bumpy surface. There is no weeping or crusting due to the use of hyoxyzone. On the extensor surface of the right shoulder there was erythema, on the surface of which there were a few papules. When the skin on the elbow was stretched, an intact scabies tract was clearly visible (see Fig. 5, b). Dermoscopy revealed 11 scabies on the hands and 3 on the feet (see Fig. 5, c). Numerous focal follicular papules up to 3 mm in diameter, bloody crusts and linear scratches were found on the abdomen, thighs and buttocks.
Rice.
5. Patient R., 61 years old. Scabies complicated by microbial eczema that arose when scratching the LSK: a focus of microbial eczema on the right elbow with barely visualized lenticular papules up to 5 mm in diameter (SLK) (a); intact itch on the right elbow (b), intact itch in the area of the left ankle (c). Final diagnosis (laboratory confirmed): scabies complicated by microbial eczema.
Scabies was treated with 20% benzyl benzoate ointment: the drug was rubbed into the entire skin, except the face and neck, once a day at night on the 1st and 4th days of the course. For the treatment of microbial eczema, the antihistamine drug cetirizine hydrochloride (parlazine) was prescribed orally, 1 tablet at night for a course of 10 days; externally - betamethasone dipropionate with gentamicin and clotrimazole ( Akriderm GK
) once a day at night.
After the infiltration resolved, three lenticular papules with a diameter of 5-7 mm (LPP) became clearly visible. Akriderm GK
was rubbed into them until complete resolution.
Process dynamics
. Clinical manifestations of scabies resolved after a week, microbial eczema - after 15 days, and LSK - after 1 month.
Mistakes made by a doctor when caring for a patient.
1. Anamnesis of the disease was not collected. Staying in the same bed with a child suffering from itchy dermatosis is an alarming fact in terms of scabies infection.
2. I didn’t pay attention to the dynamics of the development of the focus of microbial eczema - first the LC appeared, when scratching it the inflammatory reaction intensified, infiltration, pustules, and weeping appeared.
Pros and cons of benzyl benzoate
Benzyl benzoate has a number of obvious advantages over other agents:
- A proven formula, known to specialists at the beginning of the last century.
- Low price.
- Ability to penetrate deep layers of skin.
However, there are disadvantages. The drug has not been improved for a long time, so it acts more slowly than many new medications. It also has a sharp, specific odor and in some cases provokes adverse reactions. But, given the effectiveness and low cost of the drug, it still remains popular.
Reviews
Source: otzovik.com
Alternative remedies for head lice
In addition to benzyl benzoate, there are other means aimed at combating head lice.
Spray
Lice sprays, such as Full Marks, Bars, Nyuda, Pediculen and others, have a number of advantages. They act quickly and are easy to use. They are applied along the entire length of the hair from roots to ends and gently rubbed into the scalp, wait for the time specified in the instructions and rinse with warm water. After washing, you need to comb out the insects using a special comb.
Pills
Anti-lice tablets, such as Butadione, Albendazole, Levamisole and others, are usually prescribed if there are contraindications to topical agents (for skin diseases, wounds, scratches). To destroy parasites, you need to take them in a course of about 15 days . Medicines have a number of contraindications, so they should only be prescribed by a doctor.
Shampoo
At the pharmacy you can buy special shampoos such as Nyx, Hygia, Paranit and others. They can be used for both treatment and prevention of head lice. The products are applied to the hair and left under polyethylene for the period specified in the instructions, then washed thoroughly . After this, the hair is combed and washed using regular shampoo.
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Folk remedies
Many people prefer to use time-tested folk remedies for head lice. A vinegar solution is often used to help kill parasites. Another popular option is lathering with tar soap, which remains on the hair for half an hour. Kerosene is also used - in this case, caution is needed, since it is an aggressive product that, if the rules of use are not followed, can cause scalp burns and hair loss.
Despite the appearance in pharmacies of numerous new drugs for head lice, benzyl benzoate remains a popular remedy . This is due to its effectiveness and very low price. To get the maximum result from using the medication and prevent side effects, you need to follow the instructions and take precautions.
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Price
You can buy benzyl benzoate to get rid of lice at the pharmacy. The price for a standard 25 g package of ointment varies from 20 to 50 rubles. For 200 ml of emulsion you will have to pay approximately 120–150 rubles. The cost depends on the volume of the bottle, manufacturer, and region of purchase.
The amount of drug required to completely get rid of parasites varies. The required volume depends on the length, thickness of the hair, the effectiveness of a single procedure, and the thoroughness of the mechanical treatment. For 1 rubbing, on average, from 25 to 50 g of product are spent. In this case, the emulsion is consumed more economically.
It is known that the fight against pediculosis must be started as quickly as possible, covering everyone who is in close contact. Benzyl benzoate in the form of an ointment or essence for treatment, among a wide range of medicines, is affordable, convenient, effective, and therefore invariably becomes the choice of consumers.
Find out more about head lice thanks to our articles:
- what lice look like;
- types of lice, their differences;
- where do lice come from;
- how to understand that you have lice or symptoms of the disease;
- can lice appear from nerves;
- what do lice bites on a person’s head look like?
- Why lice are dangerous, what diseases they can carry.
