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Morris GC, Haddow L, Sashidharan P. Is scabies an increasing problem in the UK, and how should the UK Health Security Agency and sexual health services respond? Sex Transm Infect 2024; 100:60. [PMID: 38233022 DOI: 10.1136/sextrans-2023-055991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Affiliation(s)
| | - Lewis Haddow
- Wolverton Centre for Sexual Health, Kingston Hospital NHS Foundation Trust, Kingston upon Thames, UK
| | - Parameswaran Sashidharan
- Homerton Sexual Health Service, Clifden Centre, Homerton Healthcare NHS Foundation Trust, London, UK
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Riebenbauer K, Purkhauser K, Walochnik J, Urban N, Weber PB, Stamm T, Handisurya A. Detection of a knockdown mutation in the voltage-sensitive sodium channel associated with permethrin tolerance in Sarcoptes scabiei var. hominis mites. J Eur Acad Dermatol Venereol 2023; 37:2355-2361. [PMID: 37356045 DOI: 10.1111/jdv.19288] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/01/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Increasing evidence has sparked a debate on the loss of sensitivity of scabies mites to conventional permethrin therapy. Mutations in the voltage-sensitive sodium channels (VSSC) were associated with knockdown resistance (kdr) in many arthropods, but have never been identified in Sarcoptes scabiei variatio (var.) hominis mites. OBJECTIVES To identify factors contributing to therapy failure. METHODS Sixty-seven mites were collected from 64 scabies-infested patients in Vienna, Austria, of whom 85.9% were refractory to prior permethrin-based treatments, and genotyped for the presence of nucleotide polymorphisms in Domain II of the VSSC, known to be associated with kdr. Information regarding previous antiscabietic therapies, decontamination procedures and possible re-infestations by contacts as well as the response to re-imposed therapies were obtained. RESULTS Sequence alignment comparisons revealed previously unidentified mutations in the coding region of Domain II of the VSSC. A novel A1663T transversion was detected in 97.0% of the mites, resulting in a non-synonymous substitution from methionine to leucine, M918L, a mutation known to confer kdr in other arthropods. In addition, a synonymous G1659A transition was identified in one mite, which otherwise showed a nucleotide sequence identical to the wild-type reference. No major inconsistencies were observed within the previous therapeutic and decontamination procedures, which could have accounted for the observed non-responsiveness to permethrin-based therapies. Subsequent cure of infestation was achieved in 65.6% of the participants, predominantly by combination therapies with topical permethrin and systemic ivermectin. However, in 14.6% of the cured cases, permethrin monotherapy sufficed for eradication of scabies, albeit in some cases prolonged exposure was necessary. CONCLUSIONS The kdr-associated M918L mutation in the VSSC gene has now emerged in S. scabiei var. hominis mites. Hence, loss of sensitivity to permethrin due to kdr-type resistance may be more prevalent than anticipated and may be decisive for the therapy responsiveness of scabies-infested patients.
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Affiliation(s)
- K Riebenbauer
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - K Purkhauser
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - J Walochnik
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - N Urban
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - P B Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - T Stamm
- Center for Medical Data Science, Institute of Outcomes Research, Medical University of Vienna & Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - A Handisurya
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Meyersburg D, Welponer T, Kaiser A, Selhofer S, Tatarski R, Handisurya A, Bauer JW. Comparison of topical benzyl benzoate vs. oral ivermectin in treating scabies: A randomized study. J Eur Acad Dermatol Venereol 2023; 37:160-165. [PMID: 36097258 PMCID: PMC10087012 DOI: 10.1111/jdv.18573] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Scabies is an itchy, parasitic infection of the skin. Recent reports indicate there is a decreasing efficacy of the standard treatment of choice, topical 5% permethrin cream. OBJECTIVE To evaluate the comparative efficacy, safety and tolerability of topical benzyl benzoate (BB) with oral ivermectin in the treatment of scabies. METHODS Patients with dermoscopy-verified scabies visiting the dermatologic outpatient clinic were assessed for enrolment in the study. In total, 224 patients were enrolled and sequentially randomized into two equally sized groups. Group A received topical 25% or 10% BB for the daily use over a period of three consecutive days, group B received oral ivermectin (200 μg/kg body weight) twice, 1 week apart. Treatment outcome was evaluated by dermoscopy at a 3-week follow-up visit. RESULTS Treatment resulted in a cure rate of 87% in group A and 86% in group B. After initial therapy failure in group A, six out of eight patients showed treatment response upon repeated application of BB, five of five when retreated with ivermectin and two of two with BB plus ivermectin, respectively. In group B, successful retreatment was observed in three out of three patients with ivermectin, two of two patients with BB and 11 of 11 patients with the combination of BB plus ivermectin, respectively. Tolerability and safety profile of oral ivermectin was excellent, while BB produced short burning sensations in 14%. CONCLUSION Topical BB and oral ivermectin have shown comparable good therapeutic efficacy. Therefore, both agents constitute an adequate first-line therapy in the treatment of scabies. A combination of both agents may be considered in recalcitrant and extensively infested cases, additionally to crusted scabies.
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Affiliation(s)
- Damian Meyersburg
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University, Salzburg, Austria
| | - Tobias Welponer
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University, Salzburg, Austria
| | - Andreas Kaiser
- Department of Psychosomatics and Inpatient Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - Sylvia Selhofer
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University, Salzburg, Austria
| | - Rafaella Tatarski
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University, Salzburg, Austria
| | | | - Johannes Wolfgang Bauer
- Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University, Salzburg, Austria
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Mayer KE, Biedermann T, Posch C. European scabies challenge: What about permethrin-resistant mites? J Eur Acad Dermatol Venereol 2022; 36:e712-e713. [PMID: 35470925 DOI: 10.1111/jdv.18181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- K E Mayer
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum rechts der Isar, Technical University Munich, Biedersteiner Str. 29, 80802 München, GER
| | - T Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum rechts der Isar, Technical University Munich, Biedersteiner Str. 29, 80802 München, GER
| | - C Posch
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum rechts der Isar, Technical University Munich, Biedersteiner Str. 29, 80802 München, GER.,Faculty of Medicine, Sigmund Freud University Vienna, Freudplatz 3, 1020, Vienna, AUT
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Sunderkötter C, Wohlrab J, Hamm H. Scabies: Epidemiology, Diagnosis, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:695-704. [PMID: 34615594 DOI: 10.3238/arztebl.m2021.0296] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/26/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Scabies is a skin infestation whose incidence is apparently rising. METHODS This review is based on pertinent articles retrieved by a selective search of PubMed on diagnosis and treatment strategies. RESULTS Thread-like papules (burrows), new, intense pruritus, and dermatitis guide the suspected diagnosis which is confirmed by the microscopic or dermatoscopic demonstration of scabies mites. The first line therapy is topical application of permethrin, in accordance with the current recommendations for its use. Other treatment options include systemic ivermectin and topical crotamiton or benzyl benzoate. A combination of permethrin and ivermectin is used to treat otherwise intractable cases and is generally indicated for the treatment of crusted scabies. Known causes of treatment failure include improper application of the external agents, failure of repeated treatment with ivermectin, incomplete decontamination of furnishings and clothes, failure to simultaneously treat contact persons, absence of written documents explaining treatment modalities, and the patient's belonging to a risk group. Even though there has not yet been any direct proof of resistance of scabies mites to permethrin, there is a rising number of welldocumented cases of poor response to this agent. Moxidectin is a new substance now undergoing clinical testing. CONCLUSION Treatment of scabies according to the guidelines and the additional recommendations reported here should result in effective curing, even in cases that are thought to be intractable.
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Affiliation(s)
- Cord Sunderkötter
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale); Institute of Applied Dermatopharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale); Department of Dermatology, Venereology and Allergology, University Hospital Würzburg
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[Scabies-clinical resistance to permethrin therapy : Case reports and a critical discussion of current treatment recommendations]. Hautarzt 2021; 72:595-599. [PMID: 33721046 DOI: 10.1007/s00105-021-04783-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 10/21/2022]
Abstract
Scabies is a contagious disease with increasing frequency. This is confirmed by data from insurance companies as well as increased search queries on Google. There is a controversial discussion in the scientific literature whether the mite has become resistant to standard therapy with permethrin. One case report and a group of cases (N = 12) from a mother-child facility are described in the following demonstrating decreased effectiveness of permethrin therapy. Dermatoscopy can be helpful in diagnosis and in assessing effectiveness of therapy. Dermatoscopic criteria are shown and therapeutic concepts are critically discussed.
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Nenoff P, Süß A, Schulze I, Meißner L, Fritsch C, Schulz B, Hennig S, Borte M, Zurek M, Ginter-Hanselmayer G. [Scabies-Renaissance of an ectoparasite infection : Diagnosis and therapy-How to proceed in practice]. DER HAUTARZT 2021; 72:125-136. [PMID: 33346858 DOI: 10.1007/s00105-020-04729-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Scabies or mange is currently a common dermatosis in Germany and other countries, and should be more important in health policy. It affects a cross-section of society, including all age groups, from infants to the aged. Locals and people with a migration background both suffer from this highly contagious ectoparasite infection with excessive, predominately nocturnal itching. Clinical diagnosis represents a challenge for the experienced dermatologist due to the variety of dermatosis to be considered in the differential diagnosis. It is still unclear whether treatment failure or the recurrences observed everywhere are due to in vitro and in vivo resistance of the pathogen agent Sarcoptes scabiei against permethrin or ivermectin. Therapeutic errors seem to play a role as often not all direct contact persons are recorded and treated with antiscabious treatment. They form the reservoir for reinfections. In the event of repeated nonresponse to topical (permethrin) and/or oral antiscabious treatment, alternative topical preparations-benzyl benzoate or crotamiton-should be used. Combination with ivermectin is mandatory.
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Affiliation(s)
- Pietro Nenoff
- Labor für Medizinische Mikrobiologie, Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Mölbiser Hauptstr. 8, 04571, Rötha OT Mölbis, Deutschland.
| | - Anke Süß
- Gemeinschaftspraxis Allgemeinmedizin und Dermatologie, Kurfürstenstr. 23 a, 54616, Wittlich, Deutschland
| | - Ina Schulze
- Hautarztpraxis, Breitscheidstr. 12, 04416, Markkleeberg, Deutschland
| | - Laura Meißner
- Klinik für Kinder- und Jugendmedizin im Klinikum St. Georg Leipzig, Delitzscher Str. 141, 04129, Leipzig, Deutschland
| | - Christina Fritsch
- Klinik für Kinder- und Jugendmedizin im Klinikum St. Georg Leipzig, Delitzscher Str. 141, 04129, Leipzig, Deutschland
| | - Bettina Schulz
- Klinik für Kinder- und Jugendmedizin im Klinikum St. Georg Leipzig, Delitzscher Str. 141, 04129, Leipzig, Deutschland
| | - Silke Hennig
- Klinik für Kinder- und Jugendmedizin im Klinikum St. Georg Leipzig, Delitzscher Str. 141, 04129, Leipzig, Deutschland
| | - Michael Borte
- Klinik für Kinder- und Jugendmedizin im Klinikum St. Georg Leipzig, Delitzscher Str. 141, 04129, Leipzig, Deutschland
| | - Marlen Zurek
- Klinik für Kinder- und Jugendmedizin im Klinikum St. Georg Leipzig, Delitzscher Str. 141, 04129, Leipzig, Deutschland
| | - Gabriele Ginter-Hanselmayer
- Department of Dermatology and Venerology, Medical University of Graz, Auenbruggerplatz 8, 8036, Graz, Österreich.
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