5 ways to cure scabies 

with the Healthy Skin Program

How Often To Apply Benzyl Benzoate

In my scabies treatment schedule benzyl benzoate (BB) is applied weekly. But on the Benzemul bottle it says to apply again after 5 days. What’s the deal with that?

The following is my reply to a reader who asked about this.

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The short story:

It appears all the recommendations for applying BB every 5 days traces back to one paper written around 1941. And it appears the good doctor I. F. Mackenzie simply chose a time interval that seemed appropriate to him.

So how often one applies BB isn’t a hard and fast rule. 

With crusted scabies one applies it very frequently (as often as every other day).

With normal scabies once a week is sufficient, but if you want to apply it every 5 days, you can. And one has the option to apply it two days in a row, especially during the first 2 weeks.

It can irritate your skin, so there is good reason not to apply it any more often than needed.

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The very long story:

I wrote the directions for using benzyl benzoate (BB) five years ago when I was treating my own case of scabies. I didn’t make anything up; I drew everything from medical or scientific sources (in other words, I don’t use the crazy Topix forum or other rumor mills as sources).

The life cycle of the scabies mite is 10-14 days, meaning after an egg hatches it takes 10-14 days for the mite(s) to be mature enough to mate and start laying new eggs…thus starting a new generation. By repeating any of the treatments every 7 days the mites are killed off while they are still immature. So there really isn’t any reason I know of to vary the schedule regardless of which treatment is chosen (BB, permethrin, sulfur or ivermectin).

Plus can be a problem with directions being quoted because whoever is writing them is usually simply repeating whatever they read somewhere. That’s why I try like the devil to find an original, reliable source to quote…and it ain’t always possible. To me, the best sources are clinical trials because they are reporting what they actually did and how patients responded. 

BUT there are variations in frequency of treatments depending on the severity of the scabies case. With crusted scabies (the most severe cases) the treatment can be every other day for the first week and then "2-3 times a week until cured” (page 8 of the 2015 Healthy Skin Program booklet). Crusted scabies is uncommon and anyone who has it should see a doctor and should really be in the hospital, so that isn’t what my schedule calls for. The treatment schedule I describe is for anything from a mild to a stubborn case of scabies, but not crusted scabies. Maybe I should add a page about crusted scabies…I do worry about people going overboard in treating themselves…I know in my case I did a time or two.

So I am re-researching this to see what’s what. Partly to figure out where I got the “every 7 days” but more to figure out what is “correct”. 

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In the Healthy Skin Program booklet on page 4 it says with “normal” scabies if the permethrin cream hasn’t worked,

“…treat with whole-body application of benzyl benzoate. 

Leave the lotion on for 24 hours, and repeat treatment in 1 week. “

whereas with crusted scabies on page 8 it says,

"Apply to the whole body second daily after bathing for the 1st week, then 2-3 times weekly until cured."

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On my BB page I site the Mayo Clinic as my source, but when I look there now I see they currently say,

"For scabies infestation:

    •    Adults—Use just one time. For severe cases, treatment may be repeated after twenty-four hours one time anytime within five days."

The WHO (World Health Organization) says,

"The lotion is usually applied once daily at night on 2 consecutive days. This may be followed by a single application at night 3 days later." (Note: you may need to click on”Scabicides and pediculicides” and then “Benzyl Benzoate)

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The Ministry of Health in Malaysia in their guideline booklet says (page 20) for permethrin or benzyl benzoate, 

"Repeat the treatment after seven (7) days to kill newly hatched mites.”

But they also say on the same page,

"Always follow the directions on the product label."

 I tripped over this research on BB from 1941 which may well be the original source of the every 5 days treatment. They used a BB emulsion (a thin lotion) they call “proscabin”. They don’t describe the ingredients (and even Google can’t find anything on it).

Anyway, they brushed it on two days in a row. Then they say, “Under the procedure now in operation a child can be pronounced free from infection on the fifth day after diagnosis…” and “If a second course is deemed necessary the child can be passed fit for school on the ninth day.” meaning the second application was on the fifth day.

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So it appears all the recommendations for applying BB every 5 days traces back to one paper written around 1941. And he simply chose a time interval that seemed appropriate to him.

​

So how often one applies BB isn’t a hard and fast rule. 

With crusted scabies one applies it very frequently (as often as every other day).

With normal scabies once a week is sufficient, but if you want to you can apply it every 5 days.

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