Patterns of Scabies Treatment Among Syrian Dermatologists: A Cross-Sectional Study

Scabies, caused by Sarcoptes scabiei var. hominis, remains a significant public health problem in Syria, where socioeconomic hardship and overcrowding contribute to persistent transmission. This study examines current treatment practices among Syrian dermatologists and evaluates the extent to which these practices align with internationally recommended management approaches.

A structured online questionnaire was administered to 159 dermatologists across multiple Syrian provinces. The survey captured detailed treatment practices, including the exact permethrin regimen applied, frequency and pattern of applications, alternative or intensive regimens, reasons for deviating from guideline-recommended weekly application, management of household contacts, estimated adherence rates, perceived treatment resistance, and reported adverse effects. Additional items assessed the use of adjunctive therapies and clinician demographics. International guideline adherence was defined as applying 5% permethrin to the whole body for 8-12 h and repeating after 1 week. Responses were analyzed in SPSS using descriptive statistics and appropriate inferential tests.

Only 54 physicians (34.0%) of participants reported using the classical weekly permethrin regimen, 87 (54.7%) used modified permethrin-based regimens (e.g., three times weekly for 2 weeks), and 18 (11.3%) used sulfur as first line. The most reported reasons for not following the classical protocol included poor patient or household-contact adherence (57.1%) and medication-related concerns such as perceived resistance or reduced drug effectiveness (37.1%). Skin irritation was reported variably, and combination therapy was used by nearly one-third of respondents. Most respondents (N=139, 87.4%) estimated contact adherence to be below 80%.

Syrian dermatologists employ a variety of treatment strategies for scabies, largely influenced by patient adherence, perceived drug resistance, and conflict-related limitations. The findings underscore the need to strengthen patient and household education, enhance physician training, and renew adherence to guideline-based management.