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The Effectiveness of 5% Tea Tree Oil cream, 10% Tea Tree Oil cream, and
5% Permethrin Cream for Scabies Treatment in Pediatric Patients
Chesia Christiani Liuwan1, Muhammad Yulianto Listiawan1, Dwi Murtiastutik1, Evy
Ervianti1, Sawitri1, Cita Rosita Sigit Prakoeswa1, Linda Astari1, Farhat Surya Ningrat2,
Kurniati3, Endang Wahyu Fitriani4, Irmadita Citrashanty1, Regitta Indira Agusni1,
Iskandar Zulkarnain1
1Department of Dermatology and Venereology, Faculty of Medicine Universitas Airlangga, dr.
Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
2Syarifah Ambami Rato Ebu General Hospital, Bangkalan, Indonesia
3 Ibnu Sina Provincial General Hospital, Surabaya, Indonesia
4 Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
ABSTRACT
Background: Scabies, an infectious disease caused by Sarcoptes scabiei mites, is still one of the most common skin diseases
found in developing countries, including Indonesia. The 5% permethrin cream for scabies treatment has been investigated as
having 2–3 time to cure scabies. Tea Tree Oil (TTO) is one of the agents that has been proven to have acaricidal potential as
an anti-inflammatory, antibacterial, and antipruritic agent. It has minimal side effects in topical use. Purpose: To evaluate the
effectiveness of 5% TTO cream and 10% TTO cream in scabies treatment of pediatric patients. Methods: This was an
experimental, analytical study with controlled clinical trial methods, and a double-blind, parallel design comparing 5% TTO
cream (treatment 1), 10% TTO cream (treatment 2), with 5% permethrin cream (control) to children with scabies. Result: The
5% TTO cream gave a cure rate of 61.5% and was significantly different from the 5% permethrin cream groups with a p-value
= 0.044 in the first week of the study. The 5% permethrin cream gave a cure rate of 15.4%, and the cure rate of 10% TTO
cream was 53.8% in the first week of the study. Conclusion: There was a significant difference between the 5% TTO cream
and 5% permethrin cream in the first week of the study. The highest and fastest cure rates were found in the 5% TTO cream
treatment group.
Keywords: scabies, tea tree oil, permethrin, children.
Correspondence: Iskandar Zulkarnain, Department of Dermatology and Venereology, Faculty of Medicine, Universitas
Airlangga/Dr. Soetomo General Academic Teaching Hospital, Jl. Mayjend Prof. Dr. Moestopo No. 6-8 Surabaya 60131,
Indonesia. Telepon: 0818309859, email: zuljazid@yahoo.com.
INTRODUCTION
Scabies, an infectious disease caused by
Sarcoptes scabiei mite, is still one of the most common
skin diseases found in developing countries, including
Indonesia. Every year, there are approximately 300
million cases of scabies in worldwide.1 Symptoms of
this disease are severe itching, especially at night with
clinical manifestations of papules and pustules
accompanied by tunnel-shaped lesions where S. scabiei
is lodged in the epidermis. Scabies also causes
complications such as rheumatic fever, nephritis, and
sepsis, which are caused by secondary infection by
Group A Streptococcus sp. or Staphylococcus aureus.2
Scabies is generally occurred in low economic areas,
areas with limited resource, and areas where people
have to live in close proximity such as prisons, nursing
homes, and dormitories. In addition, low socio-
economic conditions, lack of hygiene, crowded
neighborhoods, lack of nutrition, and sexual behavior
are risk factors for the spread of scabies.3
Although scabies is a highly prevalent disease and
potentially cause life-threatening complications, there
has been not enough attention that is still considered a
neglected disease. Treatment for scabies has now been
investigated to have alarming local and systemic side
effects, and its safety has not yet known in elderly
patients, patients with impaired liver function, in
patients younger than five years old, and in pregnant
women. Several studies conducted in Australia found
that the survival time of S. scabiei after exposure to
acaricide drugs has increased to 2 to 3 times compared
to 10 years ago.1
The diagnosis of scabies is made through clinical
manifestations and microscopic examination.
Identifying lesions can be difficult because it often
becomes unclear due to eczema or impetigo. A
presumptive diagnosis can be made based on a history
200
The Effectiveness of 5% Tea Tree Oil cream, 10% Tea Tree Oil cream, and
5% Permethrin Cream for Scabies Treatment in Pediatric Patients
Chesia Christiani Liuwan1, Muhammad Yulianto Listiawan1, Dwi Murtiastutik1, Evy
Ervianti1, Sawitri1, Cita Rosita Sigit Prakoeswa1, Linda Astari1, Farhat Surya Ningrat2,
Kurniati3, Endang Wahyu Fitriani4, Irmadita Citrashanty1, Regitta Indira Agusni1,
Iskandar Zulkarnain1
1Department of Dermatology and Venereology, Faculty of Medicine Universitas Airlangga, dr.
Soetomo General Academic Teaching Hospital, Surabaya, Indonesia
2Syarifah Ambami Rato Ebu General Hospital, Bangkalan, Indonesia
3 Ibnu Sina Provincial General Hospital, Surabaya, Indonesia
4 Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
ABSTRACT
Background: Scabies, an infectious disease caused by Sarcoptes scabiei mites, is still one of the most common skin diseases
found in developing countries, including Indonesia. The 5% permethrin cream for scabies treatment has been investigated as
having 2–3 time to cure scabies. Tea Tree Oil (TTO) is one of the agents that has been proven to have acaricidal potential as
an anti-inflammatory, antibacterial, and antipruritic agent. It has minimal side effects in topical use. Purpose: To evaluate the
effectiveness of 5% TTO cream and 10% TTO cream in scabies treatment of pediatric patients. Methods: This was an
experimental, analytical study with controlled clinical trial methods, and a double-blind, parallel design comparing 5% TTO
cream (treatment 1), 10% TTO cream (treatment 2), with 5% permethrin cream (control) to children with scabies. Result: The
5% TTO cream gave a cure rate of 61.5% and was significantly different from the 5% permethrin cream groups with a p-value
= 0.044 in the first week of the study. The 5% permethrin cream gave a cure rate of 15.4%, and the cure rate of 10% TTO
cream was 53.8% in the first week of the study. Conclusion: There was a significant difference between the 5% TTO cream
and 5% permethrin cream in the first week of the study. The highest and fastest cure rates were found in the 5% TTO cream
treatment group.
Keywords: scabies, tea tree oil, permethrin, children.
Correspondence: Iskandar Zulkarnain, Department of Dermatology and Venereology, Faculty of Medicine, Universitas
Airlangga/Dr. Soetomo General Academic Teaching Hospital, Jl. Mayjend Prof. Dr. Moestopo No. 6-8 Surabaya 60131,
Indonesia. Telepon: 0818309859, email: zuljazid@yahoo.com.
INTRODUCTION
Scabies, an infectious disease caused by
Sarcoptes scabiei mite, is still one of the most common
skin diseases found in developing countries, including
Indonesia. Every year, there are approximately 300
million cases of scabies in worldwide.1 Symptoms of
this disease are severe itching, especially at night with
clinical manifestations of papules and pustules
accompanied by tunnel-shaped lesions where S. scabiei
is lodged in the epidermis. Scabies also causes
complications such as rheumatic fever, nephritis, and
sepsis, which are caused by secondary infection by
Group A Streptococcus sp. or Staphylococcus aureus.2
Scabies is generally occurred in low economic areas,
areas with limited resource, and areas where people
have to live in close proximity such as prisons, nursing
homes, and dormitories. In addition, low socio-
economic conditions, lack of hygiene, crowded
neighborhoods, lack of nutrition, and sexual behavior
are risk factors for the spread of scabies.3
Although scabies is a highly prevalent disease and
potentially cause life-threatening complications, there
has been not enough attention that is still considered a
neglected disease. Treatment for scabies has now been
investigated to have alarming local and systemic side
effects, and its safety has not yet known in elderly
patients, patients with impaired liver function, in
patients younger than five years old, and in pregnant
women. Several studies conducted in Australia found
that the survival time of S. scabiei after exposure to
acaricide drugs has increased to 2 to 3 times compared
to 10 years ago.1
The diagnosis of scabies is made through clinical
manifestations and microscopic examination.
Identifying lesions can be difficult because it often
becomes unclear due to eczema or impetigo. A
presumptive diagnosis can be made based on a history
of typical pruritus, pruritus that gets worse at night,
distribution of the lesion, and a history of contact with
other scabies patients. Definitive diagnosis is through
microscopic findings of scabies mites, eggs, pieces of
eggshell, or fecal matter (scybala) taken from a skin
scraping from papules or under the nails. On
dermoscopy, S. scabiei looks like a dark triangular
shape resembling the letter "V". In the absence of mites
found or negative dermoscopic examination, the
diagnosis is based on clinical findings and
epidemiology.4,5
Tea Tree Oil (TTO) is a derivate of essential oil
attained from the distillation of leaves and terminal
branches of the Melaleuca alternifolia plant. TTO is a
colorless or pale yellowish liquid, clear, and has a scent
of terpenes, conifer, and minty, camphoraceous. TTO
is an agent that has been proven in vivo and in vitro to
have an acaricidal potential. TTO has three main
components, namely terpinene-4-ol, γ-terpinene, and
α-terpinene, which has anti-inflammatory,
antibacterial, and antipruritic properties, with very
minimal side effects in topical use. Topical TTO
preparations will have several advantages as scabies
therapy, which are more economical, easy to use, and
can be implemented in various communities as a
traditional medicine.1
TTO has a promising acaricidal effect against
scabies mites in vitro. It has been used successfully as
a topical adjuvant treatment in the treatment of crusted
scabies, including cases that do not respond to standard
therapy. The combined effects of acaricidal,
antibacterial, antipruritic, anti-inflammatory, and
wound healing effects on TTO can potentially reduce
scabies infection due to bacterial complications.1,6 TTO
has been used as a remedy for several diseases such as
acne, eczema, skin infections such as herpes simplex
and warts, wounds, burns, insect bites, dandruff, and
nail mycosis.6 TTO as essential oil is also used as
therapy for dermatosis, respiratory infection, oral and
vaginal, and antiseptic and disinfectant.6
Terpinen-4-ol, at 0.125% concentration, can
inhibit the production of several inflammatory
mediators, such as tumor necrosis factor α, interleukin-
1β, and prostaglandin E2, equivalent to the production
of superoxide, thereby reducing the inflammatory
response. TTO has been shown to reduce the
inflammatory response to the skin, including responses
to insect bites, bee stings, hives/itches, and metal-
induced hypersensitivity. This is due to the ability of
TTO to modulate vasodilation and plasma
extravasation related to inflammation caused by
histamine.1,8
Various compounds in TTO have different use
profiles. For example, terpinen-4-ol, a major
component of TTO, exhibits strong anti-inflammatory,
antimicrobial and anti-tumor properties9, while 1.8-
cineole is an unwanted allergen in TTO products. The
anti-inflammatory activity of TTO is mediated by the
reduction of TNF α, IL-1, IL-8, prostaglandin E, and
superoxide monocytes. Topical TTO can regulate
wheal and flare by reducing histamine-induced edema.
TTO is an excellent alternative antioxidant. Its
antioxidant activity reflects the properties of α-
terpinene, α-terpinolene, and γ-terpinene.8
There are no studies that examine the
effectiveness of acaricide drugs. Permethrin 5% works
by blocking sodium channels in parasitic organs that
can cause paralysis and arthropod death. The
mechanism of the 5% TTO as an acaricide drug is
thought to be the same as that of other acaricide drugs,
blocking the sodium channel causing paralysis of the
arthropods.10 TTO is believed to block the parasitic
motility which causes elimination of the parasite from
the host. One example of an anti-parasitic drug,
Levamisole, works as an agonist on the nicotinic
acetylcholine receptor in the parasitic neuromuscular
junction, causing neuromuscular depolarization and
spastic paralysis of the parasite.8
The topical application of TTO has a low
incidence of side effects. The most frequent side effects
are irritant and allergic reactions to the oil. Irritant
reactions can be significantly avoided through a lower
concentration. Although the threshold limits for irritant
reactions have not been described, TTO with
concentrations below 25% is said to rarely cause side
effects.11,12
METHODS
This study was an experimental, analytical study
using controlled clinical trial methods, random pair
selection, and a double-blind, parallel design
comparing 5% TTO cream (treatment 1), 10% TTO
cream (treatment 2) with 5% permethrin cream
(control) on child scabies.
The inclusion criterion was scabies patients aged
5 to 16 years old who were willing to participate in the
study by signing informed consent. The diagnostic
criteria for scabies are the presence of a burrow in the
form of linear or winding and/or a typical scabies
lesion, i.e., the discovery of papules or pustules in the
area of scabies predilection, a complaint of itching,
especially at night, and similar complaints in the family
or close people were present, and/or the presence of
triangular structure in the form of the letter 'V' in a
dermoscopic examination, and/or one of the following
is obtained from light microscopy: eggs, larvae, lice, or
fleas. The exclusion criteria were patients with a
secondary infection, patients with severe systemic
201
Original Article
The Eectiveness of 5% Tea Tree Oil cream, 10% Tea Tree Oil cream,
and 5% Permethrin Cream for Scabies Treatment in Pediatric Patients
abnormalities, patients with immunosuppression, and
Norwegian/crusted scabies.
The sampling technique was consecutive,
selecting participants who pass the inclusion and
exclusion criteria at the Nurul Cholil Islamic Boarding
School in Bangkalan. A total of 39 samples were then
divided into three groups, and each group consisted of
13 people. The allocation of samples to the treatment
and control group was done randomly.
The procedure and objective of the study were
conveyed to the eligible samples and their guardians,
and if they are willing to participate in the research,
informed consent will be signed by the representative
of the Nurul Cholil boarding school, Bangkalan.
Subjects were interviewed, then underwent physical
examinations to measure weight and height, inspect
and palpate the location of the complaint, conduct a
dermoscopy examination, and dermal lesion scrapings.
The subjects were then prescribed with cream for night
use after they shower. The subjects applied the cream
all over their bodies, including the crease areas and
areas without complaints, as instructed. The cream was
left for 8 hours and rinsed in the following day. The
cream can be reapplied once a week if there is positive
sign of scabies, established by a doctor’s physical
examination.
In the following week, the first week, the first
evaluation included physical examination, dermoscopy
examination, and scrapping examination. If all
examinations showed negative results, the subject
would be declared cured. If one of the examinations
showed a positive result, the subject would be
prescribed with the cream for the second time (the first
repetition). The second evaluation was carried out in
the following week, the second week, using the same
method and criteria. Should the tests showed at least
one positive result, the subject would receive the
treatment for the third time (the second repetition) and
re-evaluate the following week, which was the last
evaluation. If one of the test results showed positive,
then the research subject would be declared not cured.
RESULTS
This research is a clinical trial conducted in
August to October 2019 aimed to compare the 5% TTO
cream and 10% TTO cream to 5% permethrin cream,
which has been used as standard therapy in treating
scabies in this research. Subjects who participated in
this study were patients who had positive results on
physical examination and positive results on either
scrapping or dermoscopic examinations for scabies
infection. Two positive results from the three
examinations aim to increase the diagnostic value of
scabies in this study. Thirty-nine subjects participated
in this study, and they were divided into 3 treatment
groups, consisting of 13 participants each group. Each
group received 5% permethrin cream, 5% TTO cream,
10% TTO cream, respectively. This was a double-blind
study in which the creams had identical packaging and
numbered accordingly. Therefore, only the researcher
knew which cream was which.
Table 1 shows that most research subjects were
males, amounting to 82.1%. The Pearson Chi-Square
test shows a value of p = 0.498, which means that the
data distribution of sex in the three study groups was
not different. The high prevalence of scabies in male
children was possible because of the sex ratio. There
were 2,000 males and 1,200 females in Nurul Cholil
Islamic boarding school. Also, males’ poorer self-
hygiene and care may contribute to the disease.
Females tend to be more attentive to complaints and are
responsive to seek treatment compared to males. Poor
self-hygiene behaviors include sharing towels, sharing
bed which facilitates skin-to-skin contact with scabies
sufferers, and not immediately wash clothes after use.13
The age range of the subjects was 10–16 years
old. A retrospective study conducted by Paramita in
2015 on scabies in the Dermatology and Venerology
Outpatient Clinic of Dr. Soetomo General Academic
Hospital, Surabaya states that the highest prevalence
(63.8% of 282 patients) of scabies was observed in 4–
14 years age group.14 Kruskal Wallis p score was 0.257,
which means that no difference in terms of age range
between the study groups. This was because the
majority of research subjects were in the same age
group (early teens), where someone has begun to
understand pay attention to their health. Early
adolescence is a turning point age where someone
interacts more with other people. Scabies that infects
skin between fingers and toes and are visible. This can
cause embarrassment and inferiority. As many as 80%
of scabies patients claim that this disease affects their
quality of life, including sleep disorders, community
stigma, and causes shame.15,16
Table 2 shows the comparison of cure rates
between 5% permethrin cream and 5% TTO cream.
The cure rate of 5% permethrin cream was 15.4%, and
the cure rate of 5% TTO cream was 61.5%. The
statistical analysis using the Pearson Chi-square test
showed a p-value of 0.044. It means that there were
significant differences between the two groups.
The statistical analysis of the 5% Permethrin
cream and 10% TTO cream resulted in a p-value of
0.097. It means that there was no significant difference
between the two groups. The 5% permethrin cream had
a cure rate of 15.4%, and the 10% TTO cream had a
53.8% cure rate. A similar result was obtained from a
comparison between 5% TTO cream and 10% TTO
Berkala Ilmu Kesehatan Kulit dan Kelamin – Periodical of Dermatology and Venereology Vol. 32 / No. 3 / December 2020
202
abnormalities, patients with immunosuppression, and
Norwegian/crusted scabies.
The sampling technique was consecutive,
selecting participants who pass the inclusion and
exclusion criteria at the Nurul Cholil Islamic Boarding
School in Bangkalan. A total of 39 samples were then
divided into three groups, and each group consisted of
13 people. The allocation of samples to the treatment
and control group was done randomly.
The procedure and objective of the study were
conveyed to the eligible samples and their guardians,
and if they are willing to participate in the research,
informed consent will be signed by the representative
of the Nurul Cholil boarding school, Bangkalan.
Subjects were interviewed, then underwent physical
examinations to measure weight and height, inspect
and palpate the location of the complaint, conduct a
dermoscopy examination, and dermal lesion scrapings.
The subjects were then prescribed with cream for night
use after they shower. The subjects applied the cream
all over their bodies, including the crease areas and
areas without complaints, as instructed. The cream was
left for 8 hours and rinsed in the following day. The
cream can be reapplied once a week if there is positive
sign of scabies, established by a doctor’s physical
examination.
In the following week, the first week, the first
evaluation included physical examination, dermoscopy
examination, and scrapping examination. If all
examinations showed negative results, the subject
would be declared cured. If one of the examinations
showed a positive result, the subject would be
prescribed with the cream for the second time (the first
repetition). The second evaluation was carried out in
the following week, the second week, using the same
method and criteria. Should the tests showed at least
one positive result, the subject would receive the
treatment for the third time (the second repetition) and
re-evaluate the following week, which was the last
evaluation. If one of the test results showed positive,
then the research subject would be declared not cured.
RESULTS
This research is a clinical trial conducted in
August to October 2019 aimed to compare the 5% TTO
cream and 10% TTO cream to 5% permethrin cream,
which has been used as standard therapy in treating
scabies in this research. Subjects who participated in
this study were patients who had positive results on
physical examination and positive results on either
scrapping or dermoscopic examinations for scabies
infection. Two positive results from the three
examinations aim to increase the diagnostic value of
scabies in this study. Thirty-nine subjects participated
in this study, and they were divided into 3 treatment
groups, consisting of 13 participants each group. Each
group received 5% permethrin cream, 5% TTO cream,
10% TTO cream, respectively. This was a double-blind
study in which the creams had identical packaging and
numbered accordingly. Therefore, only the researcher
knew which cream was which.
Table 1 shows that most research subjects were
males, amounting to 82.1%. The Pearson Chi-Square
test shows a value of p = 0.498, which means that the
data distribution of sex in the three study groups was
not different. The high prevalence of scabies in male
children was possible because of the sex ratio. There
were 2,000 males and 1,200 females in Nurul Cholil
Islamic boarding school. Also, males’ poorer self-
hygiene and care may contribute to the disease.
Females tend to be more attentive to complaints and are
responsive to seek treatment compared to males. Poor
self-hygiene behaviors include sharing towels, sharing
bed which facilitates skin-to-skin contact with scabies
sufferers, and not immediately wash clothes after use.13
The age range of the subjects was 10–16 years
old. A retrospective study conducted by Paramita in
2015 on scabies in the Dermatology and Venerology
Outpatient Clinic of Dr. Soetomo General Academic
Hospital, Surabaya states that the highest prevalence
(63.8% of 282 patients) of scabies was observed in 4–
14 years age group.14 Kruskal Wallis p score was 0.257,
which means that no difference in terms of age range
between the study groups. This was because the
majority of research subjects were in the same age
group (early teens), where someone has begun to
understand pay attention to their health. Early
adolescence is a turning point age where someone
interacts more with other people. Scabies that infects
skin between fingers and toes and are visible. This can
cause embarrassment and inferiority. As many as 80%
of scabies patients claim that this disease affects their
quality of life, including sleep disorders, community
stigma, and causes shame.15,16
Table 2 shows the comparison of cure rates
between 5% permethrin cream and 5% TTO cream.
The cure rate of 5% permethrin cream was 15.4%, and
the cure rate of 5% TTO cream was 61.5%. The
statistical analysis using the Pearson Chi-square test
showed a p-value of 0.044. It means that there were
significant differences between the two groups.
The statistical analysis of the 5% Permethrin
cream and 10% TTO cream resulted in a p-value of
0.097. It means that there was no significant difference
between the two groups. The 5% permethrin cream had
a cure rate of 15.4%, and the 10% TTO cream had a
53.8% cure rate. A similar result was obtained from a
comparison between 5% TTO cream and 10% TTO
cream, as shown in Table 4, with a p-value of 1.000. It
means no significant difference between the two
groups.
Table 1. Characteristics of the research subjects
Variable
Permethrin 5%,
n=13
TTO 5%,
n=13
TTO 10%,
n=13 p-Value
Sex
Male
Female
12 (92.3%)
1 (7.7%)
10 (76.9%)
3 (23.1%)
10(76.9%)
3 (23.1%)
p=0.498
(Chi Square)
Age (years)
10
11
12
13
14
15
16
0 (0%)
0 (0%)
1 (7.7%)
6 (46.15%)
1 (7.7%)
3 (23.1%)
2 (15.35%)
0 (0%)
0 (0%)
0 (0%)
2 (15.35%)
5 (38.5%)
2 (15.35%)
4 (30.8%)
1 (7.7%)
1 (7.7%)
3 (23.1%)
1 (7.7%)
2 (15.35%)
2 (15.35%)
3 (23.1%)
p=0.257
(Kruskal
Wallis)
Nutritional status
(BMI, kg/m2)
Underweight
(BMI <18.5)
Normal
(BMI 18.5–22.9)
Overweight
(BMI 23–29.9)
Obese (BMI >30)
5 (38.5%)
8 (61.5%)
0 (0%)
0 (0%)
8 (61.5%)
5 (38.5%)
0 (0%)
0 (0%)
7 (53.85%)
4 (30.8%)
2 (15.35%)
0 (0%)
p=0.740
(Oneway
ANOVA)
BMI= Body Mass Index; TTO= Tea Tree Oil
Table 2. Treatment outcomes of 5% permethrin cream and 5% Tea Tree Oil cream
Week 1
Week 2
Week 3
Permethrin 5%
(n=13)
(n=11)
(n=8)
Cured
2 (15.4%)
3 (27.3%)
3 (37.5%)
Not Cured
11 (84.6%)
8 (72.7%)
5 (62.5%)
TTO 5%
(n=13)
(n=5)
(n=2)
Cured
8 (61.5%)
3 (60%)
0 (0%)
Not cured
5 (38.5%)
2 (40%)
2 (100%)
p value (Chi Square)
0.044
TTO = Tea Tree Oil
Table 3. Treatment outcomes of 5% permethrin cream and 10% Tea Tree Oil cream
Week 1
Week 2
Week 3
Permethrin 5%
(n=13)
(n=11)
(n=8)
Cured
2 (15.4%)
3 (27.3%)
3 (37.5%)
Not cured
11 (84.6%)
8 (72.7%)
5 (62.5%)
TTO 10%
(n=13)
(n=6)
(n=5)
Cured
7 (53.8%)
1 (16.7%)
0 (0%)
Not cured
6 (46.2%)
5 (83.3%)
5 (100%)
p value (Chi Square)
0.097
TTO= Tea Tree Oil
203
Original Article
The Eectiveness of 5% Tea Tree Oil cream, 10% Tea Tree Oil cream,
and 5% Permethrin Cream for Scabies Treatment in Pediatric Patients
Table 4. Treatment outcomes of 5% Tea Tree Oil cream and 10% Tea Tree Oil cream
Week 1
Week 2
Week 3
TTO 5% cream
(n=13)
(n=5)
(n=2)
Cured
8 (61.5%)
3 (60%)
0 (0%)
Not cured
5 (38.5%)
2 (40%)
2(100%)
TTO 10%
(n=13)
(n=6)
(n=5)
Cured
7 (53.8%)
1 (16.7%)
0 (0%)
Not cured
6 (46.2%)
5 (83.3%)
5(100%)
p value (Chi Square)
1.000
TTO= Tea Tree Oil
Tabel 5. Treatment outcomes of each group in each week of evaluation
Treatment
Week 1
(n=39)
Week 2
(n=22)
Week 3
(n=15)
Permethrin 5%
2 (5.1%)
3 (13.6%)
3 (20%)
TTO 5%
8 (20.5%)
3 (13.6%)
0 (0%)
TTO 10%
7 (17.9%)
1 (4.5%)
0 (0%)
Total
17(43.5%)
7 (31.8%)
3 (20%)
TTO = Tea Tree Oil
Table 5 shows that the highest and fastest cure
rates were found in the 5% TTO cream, a treatment
group. In the first week of treatment, the 5% TTO
group had the highest cure rate compared to the other
two groups, which was 20.5% with a p-value of 0.044,
indicating no significant difference between the 5%
TTO cream group and the 5% permethrin cream. This
was possibly because of Terpinen-4-ol found in TTO,
which works by inhibiting the production of
inflammatory mediators and paralyzing arthropods by
blocking the sodium channel and the nicotinic
acetylcholine receptor agonist in the neuromuscular
junction of S. scabiei. Permethrin 5% only paralyzes S.
scabiei; therefore, it makes sense that TTO can cure
scabies more quickly. The use of 5% permethrin cream
in treating scabies also gives excellent and satisfying
results. The 5% permethrin cream is the most widely
used first-line topical drug for scabies treatment, and
some countries use it as the gold standard of therapy.
Research conducted by Goldust found that treatment
using 5% permethrin achieved a cure rate of 92.5% in
the second week of treatment.10
This study concluded that there were significant
differences between 5% TTO cream and 5%
permethrin cream in scabies treatment in the first week.
Environment is one of the factors that could not be
controlled in this study. Dense populations and close
interactions can cause reinfection and hinder the
healing process. Environmental control, such as
personal hygiene and comprehensive management, can
increase the successful rate of therapy.
REFERENCES
1. Thomas J, Carson CF, Peterson GM, Walton SF,
Hammer KA, Naunton M, et al. Review article
therapeutic potential of tea tree oil for scabies.
Am J Trop Med Hyg 2016; 94: 258–66.
2. Hay RJ, Steer AC, Engelman, Walton S. Skabies
in the developing world-its prevalence,
complications, and management. Clin Microbiol
Infect 2012; 18: 313–23.
3. Lassa S, Campbell MJ, Bennett CE.
Epidemiology of skabies prevalence in the UK.
from general practice records. Br J Dermatol
2011; 164: 1329–34.
4. Park JH, Kim CW, Kim SS. The diagnostic
accuracy of dermoscopy for skabies. Ann
Dermatol 2012; 24: 194–9.
5. Walter B, Heukelbach J, Fengler G, Worth C,
Hengge U, Feldmeier H. Comparison of
dermoscopy, skin scraping, and the adhesive tape
test for the diagnosis of skabies in a resource-poor
setting. Arch Dermatol 2011; 147-68.
6. Groot AC De, Schmidt E. Tea tree oil : contact
allergy and chemical composition. Contact
Dermatitis 2016; 75: 1–15.
7. Lee C, Chen L, Chang T, Huang C, Huang M,
Wang C. Correlations of the components of tea
tree oil with its antibacterial effects and skin
irritation. J Food Drug Anal 2013; 21: 169–76.
8. Pazyar N, Yaghoobi R, Bagherani N, Kazerouni
A. Review A review of applications of tea tree oil
in dermatology. Int J Dermatol 2012; 52: 1–7.
9. Tighe S, Gao Y, Tseng SCG. Terpinen-4-ol is the
Berkala Ilmu Kesehatan Kulit dan Kelamin – Periodical of Dermatology and Venereology Vol. 32 / No. 3 / December 2020
204
Table 4. Treatment outcomes of 5% Tea Tree Oil cream and 10% Tea Tree Oil cream
Week 1
Week 2
Week 3
TTO 5% cream
(n=13)
(n=5)
(n=2)
Cured
8 (61.5%)
3 (60%)
0 (0%)
Not cured
5 (38.5%)
2 (40%)
2(100%)
TTO 10%
(n=13)
(n=6)
(n=5)
Cured
7 (53.8%)
1 (16.7%)
0 (0%)
Not cured
6 (46.2%)
5 (83.3%)
5(100%)
p value (Chi Square)
1.000
TTO= Tea Tree Oil
Tabel 5. Treatment outcomes of each group in each week of evaluation
Treatment
Week 1
(n=39)
Week 2
(n=22)
Week 3
(n=15)
Permethrin 5%
2 (5.1%)
3 (13.6%)
3 (20%)
TTO 5%
8 (20.5%)
3 (13.6%)
0 (0%)
TTO 10%
7 (17.9%)
1 (4.5%)
0 (0%)
Total
17(43.5%)
7 (31.8%)
3 (20%)
TTO = Tea Tree Oil
Table 5 shows that the highest and fastest cure
rates were found in the 5% TTO cream, a treatment
group. In the first week of treatment, the 5% TTO
group had the highest cure rate compared to the other
two groups, which was 20.5% with a p-value of 0.044,
indicating no significant difference between the 5%
TTO cream group and the 5% permethrin cream. This
was possibly because of Terpinen-4-ol found in TTO,
which works by inhibiting the production of
inflammatory mediators and paralyzing arthropods by
blocking the sodium channel and the nicotinic
acetylcholine receptor agonist in the neuromuscular
junction of S. scabiei. Permethrin 5% only paralyzes S.
scabiei; therefore, it makes sense that TTO can cure
scabies more quickly. The use of 5% permethrin cream
in treating scabies also gives excellent and satisfying
results. The 5% permethrin cream is the most widely
used first-line topical drug for scabies treatment, and
some countries use it as the gold standard of therapy.
Research conducted by Goldust found that treatment
using 5% permethrin achieved a cure rate of 92.5% in
the second week of treatment.10
This study concluded that there were significant
differences between 5% TTO cream and 5%
permethrin cream in scabies treatment in the first week.
Environment is one of the factors that could not be
controlled in this study. Dense populations and close
interactions can cause reinfection and hinder the
healing process. Environmental control, such as
personal hygiene and comprehensive management, can
increase the successful rate of therapy.
REFERENCES
1. Thomas J, Carson CF, Peterson GM, Walton SF,
Hammer KA, Naunton M, et al. Review article
therapeutic potential of tea tree oil for scabies.
Am J Trop Med Hyg 2016; 94: 258–66.
2. Hay RJ, Steer AC, Engelman, Walton S. Skabies
in the developing world-its prevalence,
complications, and management. Clin Microbiol
Infect 2012; 18: 313–23.
3. Lassa S, Campbell MJ, Bennett CE.
Epidemiology of skabies prevalence in the UK.
from general practice records. Br J Dermatol
2011; 164: 1329–34.
4. Park JH, Kim CW, Kim SS. The diagnostic
accuracy of dermoscopy for skabies. Ann
Dermatol 2012; 24: 194–9.
5. Walter B, Heukelbach J, Fengler G, Worth C,
Hengge U, Feldmeier H. Comparison of
dermoscopy, skin scraping, and the adhesive tape
test for the diagnosis of skabies in a resource-poor
setting. Arch Dermatol 2011; 147-68.
6. Groot AC De, Schmidt E. Tea tree oil : contact
allergy and chemical composition. Contact
Dermatitis 2016; 75: 1–15.
7. Lee C, Chen L, Chang T, Huang C, Huang M,
Wang C. Correlations of the components of tea
tree oil with its antibacterial effects and skin
irritation. J Food Drug Anal 2013; 21: 169–76.
8. Pazyar N, Yaghoobi R, Bagherani N, Kazerouni
A. Review A review of applications of tea tree oil
in dermatology. Int J Dermatol 2012; 52: 1–7.
9. Tighe S, Gao Y, Tseng SCG. Terpinen-4-ol is the
most active ingredient of tea tree oil to kill
demodex mites. Translasional vision science &
technology 2013; 2: 20–5.
10. Zulkarnain I, Agusni RI, Hidayati AN.
Comparison of tea tree oil 5 % cream , tea tree oil
5 % + permethrin 5 % Cream , and permethrine 5
% cream in child scabies. International Journal of
Clinical and Experimental Medical Sciences
2019; 4: 87–93.
11. Thomas J, Davey R, Peterson GM, Carson C,
Walton SF, Spelman T, et al. Treatment of
skabies using a tea tree oil-based gel formulation
in Australian Aboriginal children: protocol for a
randomised controlled trial. BMJ Open 2018; 8:
e018507.
12. Thomas J, Peterson GM, Walton SF, Carson CF,
Naunton M, Baby KE. Skabies: an ancient global
disease with a need for new therapies. BMC
Infect Dis 2015; 15(1): 250-255.
13. Sianturi I, Sungkar S. The relationship between
hygienic practices and skabies infestation in a
boarding school in East Jakarta. eJKI 2014; 2(2):
91-5.
14. Paramita K, Sawitri. Profil skabies pada anak.
BIKKK 2015; 27(1): 41-7.
15. Heukelbach J, Mazigo HD, Ugbomoiko US.
Impact of scabies in resource-poor communities.
Curr Opin Infect Dis 2013; 26: 127–32.
16. Engelman D, Steer CA. Control Strategies for
skabies. Trop Med Infect Dis 2018; 3(98): 1-11.
205
Original Article
The Eectiveness of 5% Tea Tree Oil cream, 10% Tea Tree Oil cream,
and 5% Permethrin Cream for Scabies Treatment in Pediatric Patients
