Pharmacists are urgently calling for the Government to approve controversial ‘horse de-wormer’ drug ivermectin to treat a mite infection of the skin amid reports of rising cases and widespread treatment shortages.
The highly contagious condition, scabies, causes intense itching, a raised rash and is easily spread in close contact with others.
There has been a spike in outbreaks over the past year, particularly among the elderly in care homes and young adults at university. Experts now warn some cases are becoming harder to treat.
High Street chemists say that the main drugs used for the skin condition – creams which can be bought over-the-counter called permethrin and malathion – are regularly out of stock.
Experts believe ivermectin – an anti-parasitic drug – could be a solution. It is used in veterinary medicine – which is why it is commonly referred to as a horse de-wormer – and is routinely given to children and adults in mainland Europe and beyond to treat or prevent parasitic infections.
MIGHTY MITES: Sarcoptes scabiei, which causes the scabies infection
Ivermectin became infamous during the Covid pandemic due to claims by fringe medics that it might be a suitable treatment, and even a vaccination alternative, despite a lack of credible evidence
The drug became infamous during the Covid pandemic due to claims by fringe medics that it might be a suitable treatment, and even a vaccination alternative, despite a lack of credible evidence.
However, only one product containing ivermectin – a cream for skin condition rosacea, called Soolantra – is currently licensed for use in the UK.
Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said: ‘Scabies medicines have been on and off the shortages list for some time, and we know that ivermectin is a safe and effective treatment. But pharmacists can’t give it out. A dermatologist can prescribe it ‘off-label’, but a referral takes up huge amounts of time and resources.
‘Scabies is a worrying and stressful condition for patients because of the distressing symptoms. They’ll also likely pass it on to other people. The Government has issued special protocols in the past when there have been shortages of antibiotics and HRT formulations, which instruct pharmacists about the alternatives they are allowed to use. We need this to be issued now, to avoid further distress.’
Scabies is caused by the body’s immune reaction to a tiny mite called Sarcoptes scabiei as well as its saliva, eggs and faeces. Anyone can be affected, but it particularly harms the elderly, young people and those with weakened immune systems. It is most commonly spread by frequent or prolonged skin-to-skin contact, and outbreaks tend to happen where people are living close together.
A ward at an Inverness hospital had to be closed last month following a scabies outbreak, and Norfolk County Council recently wrote to schools warning teachers to be vigilant of symptoms. On top of a raised red rash, other tell-tale signs are ‘trails’ under the skin where mites have burrowed. It causes an intense itching which is severe enough to disrupt sleep. This can worsen the condition, leading to bacterial infections.
Guidance in the UK recommends using either permethrin or malathion creams, which must be rubbed all over the body, including under the nails. It should be kept on for up to 24 hours and has to be repeated after a week.
As an alternative, evidence suggests ivermectin – taken in pill form – is safe and equally as effective. European regulators recommend it in two doses two weeks apart for standard scabies. It can be used alongside the creams for more severe cases.
In the UK, however, a prescription can be issued only by a specialist – usually a dermatologist – for severe cases, or to treat an outbreak, according to the UK Health Security Agency.
Dr Tess McPherson, of the British Association of Dermatologists, said: ‘Dermatologists, particularly those working with young people, feel they are seeing more cases which are more difficult to treat.’
While some research has suggested this might be due to the scabies mite becoming resistant to standard treatments – just as lice that cause nits are now immune to permethrin – other studies show the drug is still effective.
Dr McPherson added: ‘It’s more likely [in cases where treatment doesn’t seem to work] that people aren’t applying them properly or leaving them on for long enough – it needs to be at least 12 hours but many benefit from 24 hours – or are being re-exposed because they aren’t treating those around them.
‘We need a national programme to get on top of this… ivermectin is not a bad option if people can’t get hold of anything else.’
Geriatrician Dr Lucy Pollock has seen two care home outbreaks in the past year, having never seen any before. ‘These are really sad because they cause so much distress. Scabies is difficult to diagnose in older people because they might have itchy skin for so many reasons,’ Dr Pollock said.
‘Applying creams to everyone twice over, including staff, isn’t easy. A single tablet might be a more effective approach.’