Common Barriers to Treatment Adherence in Pediatric Scabies

Scabies, caused by the mite Sarcoptes scabiei , is a highly contagious skin condition that disproportionately affects children in resource-limited settings. While pharmacologic treatments are generally effective, recurrence is common and may result from treatment failure or nonadherence. Treatment nonadherence, which includes early discontinuation, improper application, or failure to treat all household members, has not received sufficient attention. For dermatology nurses, who often serve as primary educators for families, understanding pseudoresistance caused by nonadherence is essential to guiding appropriate care and preventing unnecessary changes in therapy. Misinterpreting nonadherence as drug resistance may overlook opportunities for targeted counseling, including reinforcement of correct application techniques. This article analyzes nine observational studies involving children under 18 years with treatment-resistant scabies. It outlines the various factors that contribute to treatment failure secondary to nonadherence and pseudoresistance, as well as the efficacy of educational interventions to address them. Factors associated with treatment failure included limited caregiver education related to treating scabies, inability to treat contacts, inadequate follow-up, restricted medication access, and premature discontinuation. Initiatives that incorporated clinician training, on communication strategies, culturally tailored education, and follow-up reinforcement, demonstrated improved caregiver understanding and treatment completion. Structured caregiver education and community-based delivery models were consistently associated with improved adherence and reduced recurrence. Interventions centered on nursing-led education and community-level support can substantially improve adherence and reduce recurrence.