Scratching beneath the surface: An evaluation of the management of scabies 2017-2023

Possible resistance to recommended treatments for scabies has emerged recently. In response to anecdotal reports of a recent increase in treatment failure with permethrin, the British Association for Sexual Health and HIV (BASHH) released a statement alerting members to this.

To examine attendances and the treatment pathways for scabies cases seen at local sexual health clinics.

A case note review of scabies attendances between January 2017 and December 2023 was conducted. Data collected included patient demographics, clinical information, and scabies treatment histories. Statistical analysis was performed.

143 patients attended with scabies. The number of scabies cases did not appear to increase significantly from 2017 to 2023 (p = .09). There was significant increase in median number of treatments per case per year over time (p = .013). The number of individuals needing second-line treatments increased significantly over time (p-trend < 0.001).

Individuals with scabies are requiring more treatments to clear infection. Use of ivermectin has risen in the last year suggesting that second-line treatment is increasingly needed for eradication. Whilst treatment failure may be due to non-compliance with treatment and decontamination efforts for both index and contacts, the more recent change in findings could be attributed to a fall in permethrin efficacy.