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

Introduction: 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.

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

Methodology: 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.

Results: 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).

Discussion: 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.