Scabies in Ireland: Rise in cases partially due to extreme shortage of medicines, doctors say

A rise in scabies cases, abetted by extreme shortages of treatments, is posing an increasing public health issue, Irish doctors have warned.

Outbreaks of scabies, a highly contagious skin infestation caused by mites that get under the skin and lay eggs, increased three-fold last year amid shortages of the main treatment options for the condition.

The trend is in line with an increase in cases in the UK, where dermatologists this week warned that a failure to treat patients quickly is contributing to its spread.

“We’ve had shortages of some of the main treatments for years,” said north Dublin GP Ray Walley. “The big concern is if scabies gets into care homes, where it can afflict vulnerable older residents.”

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Between January 1st and December 5th last year, health authorities were notified of 27 outbreaks of scabies. This compares with just nine reported to the Health Protection Surveillance Centre in 2022 and four in 2021.

The latest outbreak, involving five cases, occurred in a nursing home in the southeast in December. As scabies is not listed as a notifiable disease it is likely that more cases are going unreported.

Dr Walley said it was “inevitable” that a further rise in cases seen in the UK will happen too in Ireland, especially given there are the same shortages of treatments here.

The usual treatment for scabies is two applications of permethrin, or malathion as a second‐line treatment, applied one week apart, with simultaneous treatment of close contacts. However, permethrin is currently unavailable in its proprietary and generic forms, according to Dr Walley.

Malathion, sold under the Derbac trade name, is on the Health Products Regulatory Authority’s medicine shortage list as being unavailable, with an expected return date of January 31st. Dr Walley said it has not been available “for years”.

A third option, benzyl benzoate, can be used when the two other treatments are unavailable, but Dr Walley pointed out that this is not funded for medical card holders.

Last year, dermatologists in University Hospital Galway reported a rise in “difficult-to-treat” scabies. Where other topical treatments don’t work, systemic ivermectin can be used.

Before March 2020, the start of the Covid-19 pandemic, scabies requiring treatment with ivermectin occurred on average once a year; this had risen to 7.5 times a year by mid-2021.

“Confinement and Covid‐19 has changed how and where people spend their time,” the researchers noted. “More households are sharing spaces for long periods, and despite lifting of lockdown restrictions, many people continue to work from home. This probably increases the risk of transmitting the parasite through direct contact or by fomites (objects that can spread infection).”

Of the disease, Dr Walley said: “It’s not about being dirty; you could get it from shaking hands with the driver of a Rolls Royce. It can affect any age group.” He added that scabies medications need to be added to the EU’s list of priority medicines.

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