Treatment of scabies (1,404 participants): 6 studies, of which 3 were randomised controlled trials (RCTs), 2 were non-randomised controlled trials, and one was a cohort study. Treatment of pediculosis (1,433 participants): 7 trials, of which 6 were RCTs.
Scabies treatment (6 studies):
A multicentre RCT demonstrated that the cure rates for lindane and permethrin, 86 and 91% respectively, were not significantly different. The results of 2 smaller trials, one of which was not randomised, showed that lindane was significantly less effective than permethrin (p<0.25 for both). A trial examining the optimal skin contact time for lindane demonstrated that 2 hours skin contact was inadequate, and at least 6 hours are required to produce a cure in 96% of patients. When treatment of a whole population with lindane was compared to treating only those with clinically recognised infestation, the respective decreases in prevalence were 42 to 0.06 and 28 to 14%.
Pediculosis capitis treatment (6 trials):
Lindane 1% shampoo was evaluated against permethrin in 2 large RCts. Permethrin was significantly more effective than lindane, and minimum cure rates were 99 and 90%, respectively (p<0.001 for both trials). One trial showed no significant difference between lindane and pyrethrins, cure rates were 88 and 95% respectively, whilst 2 trials comparing permethrin with pyrethrins did not reveal any significant differences.
Pediculosis pubis treatment (1 trial):
A small trial evaluating lindane versus permethrin failed to demonstrate a significant difference, respective cure rates were 60 and 57%.
Adverse effects:
Data from a large survey indicates that side-effects arising from the use of permethrin 1%, lindane 1%, or pyrethrins in the treatment of pediculosis capitis are uncommon, rarely medically important, and comparable in all treatment groups. Two out of 25 patients developed side-effects (erythema and breathlessness) after treatment with lindane for pediculosis pubis. Data from case reports suggests that severe adverse effects may arise from increased skin absorption of lindane when used to treat scabies.