Which scabicide has been associated with neurotoxicity in infants and young children?

• A. Lindane (Kwell)
• B. Crotamiton (Eurax)
• C. 10% sulfur ointment
• D. Permethrin (Elimite)

Answer: (A)

Lindane carries a notable risk of neurotoxicity, especially in infants and young children. It works by inhibiting GABAergic neurotransmission, which can lower the seizure threshold and lead to seizures, encephalopathy, or other CNS effects when absorbed through the skin. Infants have a higher skin surface area-to-body weight and less mature metabolic pathways, so they absorb more of the drug relative to their size, increasing systemic exposure. Because of this safety concern, lindane is generally avoided in this age group and is not used as a first-line scabicide there. In comparison, permethrin is preferred for children due to a more favorable safety profile, while sulfur ointment and crotamiton are alternative options with different efficacy and tolerability. The key point is that neurotoxicity in infants and young children is most strongly associated with lindane.