# A Randomised, Parallel-Group Study to Compare the Efficacy of 3% Phenothrin-Containing Jigger Lotion Versus Potassium Permanganate for Treatment of Tungiasis in Vihiga County, Kenya

## TL;DR

A study in Kenya compared 3% phenothrin lotion and potassium permanganate for treating tungiasis, finding early benefits with phenothrin but no long-term advantage.

## Contribution

Demonstrates the early efficacy of 3% phenothrin lotion over potassium permanganate for tungiasis treatment in a randomized trial.

## Key findings

- Single-dose 3% phenothrin showed significantly higher cure rates than potassium permanganate on days 4 and 7.
- The two-dose phenothrin group had lower cure rates than the single-dose group by day 7.
- By day 14, differences in cure rates between treatments diminished due to spontaneous flea death.

## Abstract

Tungiasis, caused by the sand flea Tunga penetrans, results in itching and pain. Effective treatments, such as dimeticones, are often unaffordable. A 3% phenothrin lotion has shown safety and efficacy in Kenyan trials. This study compared the cure rate and safety of 3% phenothrin lotion (as the intervention) and 0.05% potassium permanganate (KMnO4; as the standard-care comparator) over 14 days. This parallel-group, three-arm, non-blinded, randomised comparative trial was conducted in Vihiga County, Kenya. Participants aged ≥2 years with ≥1 viable flea on each foot were allocated (2:1:1) to KMnO4, single-dose 3% phenothrin, or two-dose 3% phenothrin groups. Overall, 415 fleas from 79 participants were followed up to day 14 (KMnO4, 213; single-dose, 129; two-dose, 73). On days 4 and 7, the single-dose phenothrin showed significantly higher cure rates (11.6% and 21.7%) than KMnO4 (0.9% and 11.7%) (p < 0.001 and p = 0.013). The differences diminished by days 10 and 14 because of spontaneous flea death. The cure rate of the two-dose group on day-7 (8.2%) was lower than that of the single-dose group. Single-dose 3% phenothrin improved early cure rates compared to KMnO4, but not by days 10–14; two-dose phenothrin showed no benefit compared with single dose from day 7 onwards.