8 ways to cure scabies
with the Healthy Skin Program
What are the ingredients in NATROBA™ Topical Suspension?
Clinical testing of spinosad for curing scabies
How to apply 0.9% spinosad lotion (Natroba™)
Benzyl benzoate treatment for head lice
Both spinosad and benzyl benzoate are used to treat head lice.
Spinosad has two advantages.
First, spinosad kills the eggs; benzyl benzoate does not kill eggs. So with benzyl benzoate you have to comb out the eggs with a special fine-tooth comb. With spinosad combing is not necessary.
Second, spinosad is non-irritating. Benzyl benzoate sometimes causes a temporary stinging or burning sensation which usually lasts about 15 minutes (2-60 minutes in 43% of patients in a study).
If you favor natural treatments or piña coladas, you’ll love spinosad. Why? It is considered a natural product, approved for use in organic agriculture by numerous nations. Spinosad’s “…combination of high efficacy, broad insect pest spectrum, low mammalian toxicity, and sound environmental profile is unique among existing products…”
Spinosad was discovered being produced by a bacteria in the crushed sugar cane of an abandoned rum still in the Virgin Islands. Ivermectin (actually its ancestor avermectin) came from a bacteria found on a Japanese golf course. Interestingly, “Spinosyn A …is comparable to the effect of avermectin on insect neurons.”
Since 1997 it has been used in the USA to kill insects on crops.
In 2021 the FDA approved spinosad for treating scabies. Specifically it approved a 0.9% spinosad cream called Natroba (in patients who are at least four years old).
Natroba™ (0.9% spinosad) is a prescription medicine and costs from $75 to $275 for a 4 ounce tube (120 mL). You would use one tube each week. You can use the Natroba™ brochure to try to get your doctor to write a prescription…if they recognize you have scabies.
Pre-measured packets of spinosad concentrate are available. Each packet can be mixed with 4 ounces of skin lotion or hair conditioner to make 4 ounces of 0.9% lotion. Click here to order pre-measured spinosad concentrate (USA and international).
Most garden spinosad sprays are only 0.5% (too weak) and may have various unknown solvents.
Active ingredient: spinosad
Inactive ingredients: water, isopropyl alcohol, benzyl alcohol, hexaylene glycol, propylene glycol, cetearyl alcohol, stearalkonium chloride, ceteareth-20, hydroxyethyl cellulose, butylated hydroxytoluene, FD&C yellow #6
From page 6 of FULL PRESCRIBING INFORMATION, NATROBA (spinosad) Topical Suspension 0.9%
You may notice benzyl alcohol in the ingredient list. That is not an ingredient in regular skin lotion.
Spinosad contains a mix of spinosyn A, the major component, and spinosyn D (the minor component), in a roughly 17:3 ratio. So sometimes you’ll see spinosad’s ingredients listing both spinosad A and D percentages. It does not dissolve easily in water so it is sometimes mixed with propylene glycol or other solvents first.
A 2009 clinical study of 1038 patients from 391 households, ages 6 months to 84 years compared spinosad and permethrin to cure head lice.
Participants used the products 1 to 2 times over 21 days. Each person was examined on day 7 and day 14 (and day 21 for participants treated twice).
85% of the spinosad users were cured.
45% of permethrin users were cured.
Most spinosad-treated participants required 1 application, whereas most permethrin-treated participants required 2 applications.
Conclusions: Spinosad, which did not require nit combing, was significantly more effective than permethrin in 2 studies reflecting actual-use conditions, and most spinosad-treated participants required only 1 application. Spinosad is a more convenient and effective treatment for pediculosis capitis (head lice).
A 2021 clinical study compared Natroba™ (prescription spinosad) and the same product without spinosad (called the “vehicle”). They found, “Spinosad at 0.9% performed better than vehicle in the treatment of scabies in these studies of subjects of 4 years of age or older”
Well duh, their product worked better with the active ingredient than without it! Whoodathunkit?
FDA approved since April, 2021.
It is applied once a week. So for a mild case one would apply it on day 1 and day 8. For more stubborn cases one would apply it on days 1, 8, 15, 22, and 29 (same as the permethrin schedule shown here). And of course one could simultaneously use either oral ivermectin or moxidectin.
Here are instructions for applying Natroba™ (0.9% spinosad lotion) for scabies:
• Apply enough spinosad lotion to completely cover the body from the neck to the soles of the feet, including the folds of the skin, between fingers and toes, and under fingernails and toenails.
• Balding patients should also apply Natroba™ to the scalp, hairline, temples, and forehead.
• Allow it to soak into the skin and dry for 10 minutes. It is recommended to use a clock or timer after the patient has completely covered their body.
• After 10 minutes, you can get dressed.
• Leave spinosad on for at least 6 hours before showering.
0.9% spinosad is applied once a week for at least two weeks in a row. Some are cured with one treatment, but it’s better to be more sure of a cure by using it twice a week apart.
Here are instructions for applying 0.9% spinosad hair conditioner for head lice:
Shake bottle well (mix it up thoroughly).
Apply a sufficient amount to cover dry scalp, then apply to dry hair. Depending on hair length, apply up to 120 mL (about 4 oz.) to adequately cover scalp and hair.
Leave on for 10 minutes, then thoroughly rinse off with warm water.
Wash hands after use.
If live lice are seen 7 days after the first treatment, a second treatment should be applied.
Other things to do:
Wash in hot water or dry-clean all recently worn clothing, hats, used bedding and towels
Wash personal care items such as combs, brushes, and hair clips in hot water
A fine-tooth comb or special nit comb may be used to remove dead lice and nits.
Benzyl benzoate usually comes with patient directions. Read them carefully before using this medicine.
Use this medicine only as directed. Do not use more of it and do not use it more often than recommended on the label. To do so may increase the chance of absorption through the skin and the chance of side effects.
Keep this medicine away from the eyes and other mucous membranes, such as the inside of the nose, because it may cause irritation . If you accidentally get some in your eyes, flush them thoroughly with water at once.
Do not use benzyl benzoate on open wounds, such as cuts or sores on the skin or scalp. To do so may increase the amount of absorption, which may increase the chance of side effects.
Your sexual partner or partners, especially, and all members of your household may need to be treated also, since the infestation may spread to persons in close contact. If these persons have not been examined for infestation or if you have any questions about this, check with your doctor.
To use this medicine for lice (directions from the Mayo Clinic):
If your hair has any cream, lotion, ointment, or oil-based product on it, shampoo, rinse, and dry your hair and scalp well before applying benzyl benzoate. NOTE: some people (about 40%) experience a temporary stinging or burning sensation when they use benzyl benzoate. This can be worse is skin is wet or damp, so dry thoroughly before using.
Apply enough medicine to thoroughly wet the dry hair and scalp or skin.
Allow the medicine to remain on the affected areas for 24 hours.
Then, thoroughly wash the affected areas with warm water and soap or regular shampoo.
Rinse thoroughly and dry with a clean towel.
After rinsing and drying, use a fine-toothed comb (less than 0.3 mm between the teeth) to remove any remaining nits (eggs) or nit shells from your hair, or, if you have fine hair, you may use a tweezer or your fingernails to pick nits out.
Natroba™ available by prescription
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