Pseudoresistance to permethrin in scabies.

Area of Science:

• Dermatology
• Parasitology
• Pharmacology

Background:

• Reports of permethrin resistance in *Sarcoptes scabiei var. hominis* infections are increasing.
• This phenomenon necessitates an investigation into potential underlying causes beyond true drug resistance.

Discussion:

• Physician-related factors include inadequate patient counseling and incorrect treatment prescribing (e.g., insufficient quantity, duration).
• Patient-related factors involve poor adherence, non-compliance, and improper application techniques (e.g., missing subungual folds).
• Other contributing factors include irritant contact dermatitis leading to treatment cessation and inappropriate use in post-scabies prurigo.

Key Insights:

• Many reported cases of permethrin resistance are likely pseudoresistance, stemming from application and adherence issues.
• Correcting counseling, treatment protocols, and patient education can potentially improve therapeutic outcomes.

Outlook:

• Further research should focus on standardizing treatment guidelines and improving patient education to address pseudoresistance.
• Enhanced understanding and management of pseudoresistance are crucial for effective scabies control programs.