Benzyl Benzoate
AHFS Class: Scabicides and Pediculicides (84:04.12)
VA Class: AP300
ATC Class: P03AX01
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Introduction
Benzyl benzoate is a scabicide and pediculicide.
Uses
Benzyl benzoate is used as an alternative agent for the topical treatment of scabies and also has been used for the topical treatment of pediculosis (lice infestation).
Scabies
Although a single treatment with topical benzyl benzoate, if used correctly, may be highly effective in eradicating scabies, the drug is not considered a treatment of choice or a preferred alternative for scabies. The American Academy of Pediatrics (AAP), the US Centers for Disease Control and Prevention (CDC), and other clinicians consider topical permethrin 5% to be the scabicide of choice because of its safety and efficacy profile relative to other available agents, particularly lindane.103 104 105 106 107 111 Recommendations for alternative therapy for the treatment of scabies differ among various clinicians.103 104 107 Some clinicians recommend topical crotamiton 10% or oral ivermectin as preferred alternatives.107 The CDC recommends topical lindane 1% (should not be used in pregnant or lactating women, children younger than 2 years of age, or individuals with extensive dermatitis) or oral ivermectin as preferred alternatives.104 However, lindane is now considered a second-line agent and should be used for the treatment of scabies only in patients who have not responded to or who cannot tolerate other recommended therapies.114 (See Uses: Scabies in Lindane 84:04.12.)
Scabicides, including benzyl benzoate, are not effective in the prophylaxis of scabies.
For further information on the treatment of scabies, see Uses: Scabies, in Permethrin 84:04.12.
Pediculosis
Although the manufacturer recommends use of topical benzyl benzoate for the treatment of pediculosis capitis (head lice infestation) and pediculosis pubis (pubic lice infestation), its effectiveness in these infestations is questionable. The CDC, AAP, and other clinicians generally recommend use of other drugs (topical permethrin 1%, topical malathion 0.5%, topical pyrethrins with piperonyl butoxide, oral ivermectin) for the treatment of pediculosis.102 103 104 107
For further information on the treatment of pediculosis, see Uses: Pediculosis, in Permethrin 84:04.12.
Other Uses
Benzyl benzoate is used to increase the solubility and stability of dimercaprol injection and as a levigating agent.
Dosage and Administration
Administration
Benzyl benzoate lotion, in an approximate concentration of 28% w/w, is applied topically. The drug should not be administered orally. Containers of the lotion should be shaken before using.
Dosage
Scabies
Before applying benzyl benzoate topically for the treatment of scabies, the patient may bathe with soap and water, taking care to scrub and remove scaling or crusted detritus, then towel dry. While still damp, a thin layer of the 28% lotion should be applied uniformly and gently massaged into all skin surfaces (entire trunk and extremities) from the neck to the toes (including the soles of the feet). The drug should not be applied to the face, eyes, mucous membranes, or urethral meatus. When this first layer of lotion has dried, a second coat should be applied. Some clinicians recommend that this treatment be repeated on each of 2 successive days. Approximately 30 mL of the lotion usually is sufficient for one application in adults and 20 mL usually is sufficient in children. The patient should bathe 24–48 hours after the last application to remove the drug.
Although the first treatment of scabies with benzyl benzoate usually is successful, treatment may be repeated after 7–10 days if mites appear or new lesions develop. Additional treatments are warranted only if live mites can be demonstrated.
Pediculosis
For the treatment of pediculosis capitis (head lice infestation) or pediculosis pubis (pubic lice infestation), the manufacturer recommends that 28% benzyl benzoate lotion be rubbed into the affected hairy areas, avoiding exposure to the eyes. After 12–24 hours, the lotion should be removed with soap and water. The manufacturer states that pediculosis may be retreated after one week.
Cautions
Adverse Effects
When used in appropriate dosage, topically applied benzyl benzoate appears to have a low order of toxicity. Slight local irritation (especially of the male genitalia), itching, and allergic skin sensitivity may occur, and contact with the face, eyes, mucous membranes, and urethral meatus should be avoided. Repeated application of benzyl benzoate frequently causes contact dermatitis.
In patients with scabies or pediculosis, pruritus (caused by an acquired sensitivity to the ectoparasites and their products) frequently persists for one to several weeks following treatment with the drug; this reaction does not indicate treatment failure and is not an indication for further treatment with benzyl benzoate.
Precautions and Contraindications
Benzyl benzoate is contraindicated in patients with a history of hypersensitivity to the drug.
Benzyl benzoate should not be applied to acutely inflamed skin or raw, weeping surfaces. If primary irritation or hypersensitivity occurs, treatment should be discontinued and the drug removed with soap and water.
Acute Toxicity
Studies in animals showed that oral ingestion of large doses of benzyl benzoate resulted in progressive incoordination, CNS excitation, seizures, and death.
Mechanism of Action
No information is available on the mechanism of action of benzyl benzoate.
Spectrum
Benzyl benzoate is toxic to the parasitic arthropod Sarcoptes scabiei (the causative organism of scabies) and may be toxic to Pediculus capitis (head louse) and Phthirus pubis (crab louse).
Resistance
Resistance of Sarcoptes scabiei to the drug has not been conclusively demonstrated.
Pharmacokinetics
Information on the systemic absorption of benzyl benzoate following topical application in humans is not available.
Chemistry and Stability
Chemistry
Benzyl benzoate is prepared synthetically by the esterification of benzoic acid with benzyl alcohol. Benzyl benzoate occurs as a clear, oily liquid having a slight aromatic odor and producing a sharp, burning sensation of the tongue. The drug is practically insoluble in water but is miscible with glycerin.
Stability
Benzyl benzoate should be stored in light-resistant containers and should not be exposed to excessive heat.
Preparations
Benzyl Benzoate
| Routes | Forms | Strengths | Brand Names | Manufacturer |
|---|
| Topical |
Lotion |
28% w/w* |
Benzyl Benzoate Lotion USP |
Prepared extemporaneously |
* available by nonproprietary name
|
Selected Revisions November 2003, © Copyright, January 1978, American Society of Health-System Pharmacists, Inc. 7272 Wisconsin Avenue, Bethesda, MD 20814. |
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References
Only references cited for selected revisions after 1984 are available electronically.
101. Brown S, Becher J, Brady W. Treatment of ectoparasitic infections: review of the English-language literature, 1982-1992. Clin Infect Dis. 1995; 20:S104-9.  
102. Mathieu ME, Wilson BB. Lice (pediculosis). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s principles and practices of infectious diseases. 5th ed. New York: Churchill Livingstone; 2000:2972-3.
103. Committee on Infectious Diseases, American Academy of Pediatrics. 2000 Red book: report of the Committee on Infectious Diseases. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2000:427-31,506-8.
104. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR Morb Mortal Wkly Rep. 2002; 51(No. RR-6):1-78. 
105. Anon. Permethrin for scabies. Med Lett Drugs Ther. 1990; 32:21-2.
106. Wendel K, Rompalo A. Scabies and Pediculosis pubis: an update of treatment regimens and general review. Clin Infect Dis. 2002; 35(Suppl 2):S146-51.
107. Anon. Drugs for parasitic infections. Med Lett Drugs Ther. Apr 2002. From the Medical Letter website (http://www.medletter.com).
108. Rico MJ, Myers SA, Sanchez MR et al. Guidelines of care for dermatologic conditions in patients infected with HIV. J Am Acad Dermatol. 1997; 37:450-72.
109. Peterson CM, Eichenfield LF. Scabies. Ped Annals. 1996; 25:97-100.
110. Kerl H, Ackerman AB. Inflammatory diseases that simulate lymphomas: cutaneous pseudolymphomas. In: Fitzpatrick TB, Eisen AZ, Wolff K et al, eds. Dermatology in general medicine. 4th ed. New York: McGraw Hill Inc. 1993:1315-27.
111. Wilson DC, Leyva WH, King LE. Arthropod bites and stings. In: Fitzpatrick TB, Eisen AZ, Wolff K et al, eds. Dermatology in general medicine. 4th ed. New York: McGraw Hill Inc. 1993:2810-26.
112. Estes SA, Estes J. Therapy of scabies: nursing homes, hospitals, and the homeless. Semin Dermatol. 1993; 12:26-33.
113. Kolar KA, Rapini RP. Crusted (Norwegian) scabies. Am Fam Physician. 1991; 44:1317-21.
114. Lindane Lotion USP, 1% prescribing information. From the FDA web site (http://www.fda.gov/cder/foi/label/2003/006309lotionlbl.pdf). Accessed 2003 Apr 4.
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