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ACTAS
Dermo-Sifiliográficas
114
(2023)
T433---T434
RESIDENT’S
FORUM
[Translated
article]
RF
---
Resistance
to
Permethrin
in
Scabies
Treatment:
Does
It
Really
Exist?
FR
---
¿Existe
una
resistencia
real
al
tratamiento
de
la
escabiosis
con
permetrina?
J.P.
Velasco-Amador,
A.
Prados-Carmona,
R.
Ruiz-Villaverde
Servicio
de
Dermatología,
Hospital
Universitario
San
Cecilio,
Inst.
Invest.
Biosanitaria
IBS
Granada,
Granada,
Spain
KEYWORDS
Scabies;
Sarcoptes
scabiei
;
Permethrin;
Treatment;
Epidemic
PALABRAS
CLAVE
Escabiosis;
Sarna;
Permetrina;
Tratamiento;
Epidemia
Scabies
is
a
highly
contagious
skin
infestation
caused
by
the
Sarcoptes
scabiei
mite.
It
is
generally
transmitted
through
direct,
prolonged,
skin-to-skin
contact,
and
its
inci-
dence
increased
following
the
COVID-19
pandemic
and
home
DOI
of
original
article:
https://doi.org/10.1016/j.ad.2022.05.036
Corresponding
author.
E-mail
address:
ismenios@hotmail.com
(R.
Ruiz-Villaverde).
confinement
measures.
1
The
first-line
treatment
for
scabies
is
5%
topical
permethrin
cream,
which
is
applied
from
head
to
toe
and
washed
off
after
8
to
12
hours.
This
treatment
is
repeated
after
7
to
14
days.
Cure
rates
of
up
to
98%
have
been
described
for
this
regimen,
1
but
recent
months
have
seen
an
increase
in
unsatisfactory
responses
to
treatment.
Treatment
failure
has
generally
been
attributed
to
var-
ious
causes,
including
incorrect
application
of
the
cream,
failure
to
simultaneously
treat
coinhabitants,
and
insuffi-
cient
disinfection
of
the
environment.
An
increasing
number
of
dermatologists,
however,
after
ruling
out
the
above
errors
and
achieving
cure
with
other
topical
treatments,
such
as
sulfur-containing
petroleum
jelly
and
sodium
benzoate,
are
suggesting
that
S.
scabiei
may
be
developing
true
resistance
to
permethrin.
In
2018,
Sunderkötter
et
al.
2
warned
of
an
increase
in
scabies
cases
in
Germany.
Among
the
possible
causes
they
mentioned
was
permethrin
resistance,
as
patients
did
not
respond
as
quickly
as
they
had
done
in
previous
years.
In
2020,
Meyersburg
et
al.
3
described
reduced
scabies
mite
susceptibility
to
permethrin
in
Austria
and
called
for
evaluation
of
alternative
treatment
options.
In
2021,
several
Italian
working
groups
also
recorded
a
loss
of
effectiveness
for
permethrin.
They
reported
that
almost
two-thirds
of
patients
in
whom
the
drug
had
failed
responded
to
another
topical
treatment,
suggesting
specific
https://doi.org/10.1016/j.ad.2022.05.046
0001-7310/©
2022
AEDV.
Published
by
Elsevier
Espa
̃
na,
S.L.U.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(
http://
creativecommons.org/licenses/by-nc-nd/4.0/
).
J.P.
Velasco-Amador,
A.
Prados-Carmona
and
R.
Ruiz-Villaverde
resistance
to
permethrin;
they
also
excluded
lack
of
compli-
ance
as
the
reason
for
this
lower
response.
4
The
different
mechanisms
proposed
for
resistance
to
permethrin
among
S.
scabiei
mites
include
increased
glutathione-S-transferase
activity,
increased
expression
of
ATP-dependent
trans-
porters
(e.g.,
multidrug-resistant
protein),
and
sodium
channel
mutations.
5
These
circumstances
have
required
dermatologists
to
resort
more
frequently
to
other
first-line
drugs,
such
as
oral
ivermectin
and
benzyl
benzoate
in
25%
solution.
Other
options
are
topical
ivermectin
1%
and
even
6%---33%
sulfur-containing
petroleum
jelly,
6
since
resistance
to
ivermectin
has
also
been
described.
5
Recent
months
have
seen
the
emergence
of
new
therapies,
such
as
spinosad
0.9%,
a
neurotoxin
recently
approved
by
the
US
Food
and
Drug
Administration
for
the
topical
treatment
of
scabies.
7
The
above
reports
point
to
the
same
issue
---
that
the
sca-
bies
mite
is
developing
increasing
resistance
to
permethrin
--- a n d
suggest
the
need
to
reconsider
its
recommendation
as
a
first-line
treatment
in
clinical
practice
guidelines
and
to
assess
other
options
that
are
showing
greater
effectiveness.
References
1.
Cerro
PA,
Navarro-Bielsa
A,
Palma
AM.
FR
---
Epidemia
de
sarna
en
el
contexto
de
la
pandemia
de
COVID-19
[Scabies
outbreak
during
the
COVID-19
lockdown].
Actas
Dermosifiliogr.
2022;113:516---8.
2.
Sunderkötter
C,
Aebischer
A,
Neufeld
M,
Löser
C,
Kreuter
A,
Bialek
R,
et
al.
Increase
of
scabies
in
Germany
and
development
of
resistant
mites?
Evidence
and
consequences.
J
Dtsch
Dermatol
Ges.
2018;17:15---23.
3.
Meyersburg
D,
Kaiser
A,
Bauer
JW.
Loss
of
efficacy
of
topical
5%
permethrin
for
treating
scabies:
an
Austrian
single-center
study.
J
Dermatolog
Treat.
2020;4:1---4.
4.
Balestri
R,
Magnano
M,
Infusino
SD,
Rizzoli
L,
Girardelli
CR,
Rech
G.
Scabies
is
becoming
less
sensitive
to
permethrin
therapy.
J
Eur
Acad
Dermatol
Venereol.
2021;35:e889---91.
5.
Khalil
S,
Abbas
O,
Kibbi
AG,
Kurban
M.
Scabies
in
the
age
of
increasing
drug
resistance.
PLoS
Negl
Trop
Dis.
2017;11:e0005920.
6.
Salavastru
CM,
Chosidow
O,
Boffa
MJ,
Janier
M,
Tiplica
GS.
European
guideline
for
the
management
of
scabies.
J
Eur
Acad
Dermatol
Venereol.
2017;31:1248---53.
7.
Seiler
JC,
Keech
RC,
Aker
JL,
Miller
W,
Belcher
C,
Met-
tert
KW.
Spinosad
at
0.9%
in
the
treatment
of
scabies:
efficacy
results
from
2
multicenter,
randomized,
double-
blind,
vehicle-controlled
studies.
J
Am
Acad
Dermatol.
2022;
86:97---103.
T434

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