Investigating scabies management in primary care and rising dermatology referrals.

Abstract

Scabies has increased across Europe over the past 20 years despite effective treatments. Reinfection, suboptimal adherence to guidelines, and social determinants are thought to contribute to persistent disease. We aimed to assess trend of consultations for scabies in our practice and survey General Practitioners (GPs) and GP trainees management of scabies. A retrospective review of dermatology outpatient and inpatient consultations for scabies was conducted in the Mid-West of Ireland over three years (2021-2023), sampling July-December annually. In parallel, an online survey assessed scabies management practices among Irish general practitioners (GPs) and trainees (n=49). Dermatology consultations for scabies increased by 625% between 2021 and 2023. Prior to dermatology review, 59% of patients had already received treatment, most commonly 5% permethrin alone. Only 32% had close contacts treated. While 26% cleared with repeat permethrin, 37% required combined permethrin and ivermectin. In the GP survey, most respondents reported rising case numbers and increasing management difficulty. Although confidence in diagnosis and treatment was high, only 18% treated all contact categories, and just one-third advised application to the face, neck, and scalp. Barriers identified included medication access, cost, compliance with contact treatment and decontamination, complex living conditions, and concerns regarding treatment failure or resistance. Persistent scabies is multifactorial, reflecting incomplete treatment, inadequate contact management, and socioeconomic barriers. Improved adherence to updated guidelines, enhanced education, and a holistic public health approach are required to reduce reinfestation and treatment failure.