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Abstract Scabies is an increasing problem in the UK with a surge in cases reported by dermatologists and the media. It is intensely itchy and caused by the highly contagious mite Sarcoptes scabiei. There are many theories regarding the increased prevalence, including global warming, increased poverty, reduced treatment availability and resistance. The standard treatments in the UK include topical malathion, topical permethrin and oral ivermectin. All have had significant supply issues as reported by the British Association of Dermatologists. There have also been concerns of permethrin resistance. Oral ivermectin is expensive, with four tablets listed at £116.84 in the British National Formulary (BNF). Finally, oral ivermectin is not licensed in children weighing 15 kg (although data seem to suggest this is safe). One option that is less used but reported is topical ivermectin. This was in the 2018 Cochrane review looking at the efficacy of topical permethrin, and oral and topical (as 1% lotion) ivermectin. This showed no difference in efficacy and few or mild adverse events. These findings are also replicated in recent studies and there are case reports of topical ivermectin to treat neonatal scabies that seems resistant to permethrin. In our centre, we have used topical ivermectin (as the 10 mg g−1 cream Soolantra) to treat 10 patients, with great success. The first was a 14-month-old child who weighed 9.2 kg. She had previously had three courses of permethrin and two courses of malathion with ongoing signs and symptoms of scabies, including burrows. The entire family had been treated every time and the entire family (except this patient) was treated with oral ivermectin during the final treatment before topical ivermectin. The patient was treated top to toe with two applications of topical ivermectin cream 1 week apart, with resolution after one application. Subsequently we have had success using the same protocol to treat a 21-year-old man (with no response to four courses of permethrin) and his 53-year-old mother (with no response to three courses of permethrin). We have also treated a 31-year-old man, a 48-year-old man and his partner (all of whom had not responded to one course of permethrin), and a 68-year-old man and his family who had no previous treatment. We have had no adverse effects and no treatment failures. We report on 10 patients who we treated successfully with topical ivermectin. Topical ivermectin provides an exciting option for treatment and, of note, one tube is listed at £27.43 in the BNF, making it significantly cheaper than the oral alternative.
Oldham et al. (Fri,) studied this question.