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

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.