Scabies in nursing homes: an eradication program with permethrin 5% cream

Area of Science:

• Dermatology
• Infectious Diseases
• Public Health

Background:

• Scabies infestations can become chronic and therapy-resistant, particularly in institutional settings like nursing homes.
• Previous treatments for scabies may be unsuccessful in certain patient populations.
• Compassionate-plea protocols allow for the use of specific treatments in challenging cases.

Purpose of the Study:

• To evaluate the efficacy of Permethrin 5% cream for treating chronic, therapy-resistant scabies.
• To assess the treatment outcomes in a large nursing home population, including residents, staff, and their contacts.
• To determine the cure rate and adverse effects associated with Permethrin 5% cream in this setting.

Main Methods:

• A compassionate-plea protocol was implemented in three nursing homes.
• Permethrin 5% cream was administered to all residents, staff, and frequent visitors, regardless of symptoms.
• Family members were treated if symptomatic or exposed; treatment efficacy was assessed post-application.

Main Results:

• Nine hundred ninety-five individuals were treated; 202 (20.3%) were diagnosed with scabies.
• Approximately 35% of nursing home residents had therapy-resistant scabies.
• An overall cure rate of 98% was achieved, with varying numbers of applications.
• Mild adverse experiences (pruritus, rash) occurred in 2.4% of cases.

Conclusions:

• Permethrin 5% cream is a highly effective treatment for chronic and therapy-resistant scabies in nursing home environments.
• Universal treatment of residents and staff, irrespective of symptoms, can help control outbreaks.
• The treatment demonstrates a favorable safety profile with minimal adverse effects.