[Scabies therapy in Germany : Results of a nationwide survey with a special focus on the efficacy of first-line therapy with permethrin].

BACKGROUND

According to the current scabies guideline, topical treatment with permethrin 5% cream is the first-line therapy of common scabies in Germany. However, in the course of growing incidence of scabies in recent years there have been increasing numbers of reports of reduced efficacy in standard therapy.

OBJECTIVE

To establish a better understanding for the efficacy of scabies therapy under practice conditions, a survey focusing on the first-line therapy with permethrin was conducted in dermatological hospitals, outpatient clinics and dermatology practices.

METHODS

The postal survey addressed all dermatologically active physicians in Germany and queried diagnostic methods, the individual initial treatment, the estimated efficacy of permethrin therapy, the frequency and reasons for therapy failures under permethrin and the therapeutic approach in case of failure of the initial therapy.

RESULTS

The efficacy of permethrin was rated with 73% by 187 physicians. About 74% reported to treat initially with 5% permethrin cream. The most common reasons identified for treatment failure were application errors, lack of compliance and inadequate hygiene measures. Suspected diminished efficacy or development of resistance against permethrin and re-infestations were also mentioned. In the case of ineffectiveness of initial therapy, most clinicians opt for oral ivermectin, a repetition of permethrin therapy or a combination of both.

CONCLUSION

Although there are localized reports of decreased effectiveness of permethrin therapy, results of this survey point towards a persisting high efficacy of first-line standard treatment of scabies with permethrin 5% cream in Germany.