A GP Survey of Scabies in Hampshire and the Isle of Wight UK (2001): Incidence, Prescribed Treatment & Treatment Failure.

C E Bennett & I Cochrane

Correspondence to Dr. C.E. Bennett, Parasite Epidemiology Unit, School of Biological Sciences, University of Southampton. SO16 7PX, E-mail: ceb@soton.ac.uk Tel: 023 80594407 Fax. 023 80594269

Introduction

Scabies is a parasitic skin infection caused by the scabies mite Sarcoptes scabei var. hominis. It can be debilitating and depressing and lead to secondary skin infections (Downs et al 1999).

Project Goals

 

Conduct a random survey of surgeries in the county of Hampshire and on the Isle of Wight (UK) n = 400 for diagnosed cases of scabies

Determine age groups affected

Determine treatments prescribed

Evaluate efficacy of currently available scabicidal therapies.

Survey Description

400 GP surgeries surveyed by questionnaire in Hampshire and IOW Approximately 250,000 of the total population of 750,000 included Surveys sent out in January 2002 146 replies: a 36.5% return rate covering a population of 112,000

Incidence

Incidence per surgery on average: 8.22 per annum.

Age groups

 

Adults were the most significant group reporting with symptoms probably due to the high number of communal living quarters present within the survey area (university halls, military barracks and nursing homes). There was a significant difference between the age groups. P= 0.01

Most frequently used treatments
 

Derbac M was the most frequently used treatment (46.1%) with ‘Lyclear Dermal cream 5%’ next at 37.6%. Other treatments commonly prescribed were Benzyl Benzoate 6.4% and Eurax 3.5%.

( N.B. Lyclear Dermal Cream (5%) (permethrin) was only introduced in the UK in 1991. There has been a rapid increase in prescribing it: rising from 26K items in 1992 to 210K items in 1998.

Most topical scabicides, including permethrin: Lyclear Dermal cream 5% and Malathion, Derbac M, are available both on prescription and over the counter and patients are able to repeat treatments without consulting their GP. The main reason for patient return in the surgeries surveyed was because they were still itching despite a full course of treatment.

A survey of consultant dermatologists in 2000 had suggested resistance to Derbac M (Bennett et al 2000) but not detected resistance to Lyclear Dermal Cream 5% The latter had therefore been recommended for use where resistance to Derbac M was suspected.

Reasons for returning to GP

 

Treatments that have failed

 

 

Conclusions

The majority of GPs surveyed thought that the number of reported cases of scabies had remained the same over the past 5 years.

55.5% of GPs surveyed had encountered a situation where the course of treatment had failed to eliminate a definite case of scabies and of the treatments used Derbac M (malathion) was the most common treatment to fail. In this study however Lyclear Cream 5% (permethrin) also had a high failure rate.

This first report of resistance to permethrin gives considerable cause for concern and is a further indicator of the rapid rise of resistance to treatment compounds by scabies mites.

40 GP surgeries in the survey have expressed willingness to participate in a prospective survey which will commence in September 2002.

 

References

Downs, A.M.R., Harvey, I. And Kennedy, C.T.C. 1999. The epidemiology of head lice and scabies in the UK, Epidemiol. Infect. 122: 471-477.

Bennett, C.E., Keefe, M., Reynolds, J.C. 2000. Perceptions of the incidence of scabies and efficacy of treatment in U.K.hospitals, British Journal of Dermatology. 143: 1319-1359.

                                  PEU

               Parasite Epidemiology Unit

Pre-publication data as feed back to participating surgeries.