Pharmacists seek drugivermectin approval for horse deworming in war on resurgent scabies

By | June 10, 2023

Pharmacists urgently ask the government to approve the controversial ‘wormer’ drug ivermectin to treat a skin mite infection amid rising case reports 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 older adults in nursing homes and young adults in college. Experts now warn that some cases are becoming more difficult to treat.

High Street chemists say the main medicines used in skincare creams that can be bought over the counter called permethrin and malathion are regularly out of stock.

Experts believe that the antiparasitic drug ivermectin could be a solution. It is used in veterinary medicine, which is why it is commonly referred to as a dewormer for horses, and is regularly given to children and adults in continental Europe and beyond to treat or prevent parasitic infections.

MIGHTY MITES: Sarcoptes scabiei, which causes scabies infection

MIGHTY MITES: Sarcoptes scabiei, which causes scabies infection

Ivermectin has become infamous during the Covid pandemic due to claims by fringe doctors that it may be a suitable treatment and even an alternative to vaccination, despite a lack of credible evidence

Ivermectin has become infamous during the Covid pandemic due to claims by fringe doctors that it may be a suitable treatment and even an alternative to vaccination, despite a lack of credible evidence

The drug has become infamous during the Covid pandemic due to claims by fringe doctors that it could be a suitable treatment and even an alternative to vaccination, despite a lack of credible evidence.

However, only one product containing ivermectin, a skin rosacea cream, 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 shortage list for some time and we know that ivermectin is a treatment safe and effective. But pharmacists can’t distribute it. A dermatologist can prescribe it “off-label,” but a referral takes enormous amounts of time and resources.

‘Scabies is a worrying and stressful condition for patients due to the painful symptoms. They will probably pass it on to other people as well. The government has issued special protocols in the past when there have been shortages of antibiotics and HRT formulations, which educate pharmacists on the alternatives they can use. We need this released now to avoid further suffering.’

Scabies is caused by the body’s immune reaction to a tiny mite called Sarcoptes scabiei as well as its saliva, eggs and feces. Anyone can be affected, but it particularly affects the elderly, young people and people with weakened immune systems. It is most commonly spread by frequent or prolonged skin-to-skin contact, and outbreaks tend to occur where people live close together.

A ward of a hospital in Inverness had to close down last month following an outbreak of scabies and Norfolk County Council recently wrote to schools warning teachers to look out for symptoms. In addition to a raised red rash, other telltale signs are “trails” under the skin where the mites have burrowed. It causes intense itching that is severe enough to disrupt sleep. This can make the condition worse, leading to bacterial infections.

Guidance in the UK recommends the use of permethrin or malathion creams, which should be rubbed all over the body, including under the nails. It should be kept up to 24 hours and should be repeated after a week.

Alternatively, evidence suggests that ivermectin taken in pill form is safe and just as effective. European regulators recommend it in two doses two weeks apart for standard scabies. It can be used alongside creams for more severe cases.

In the UK, however, a prescription can only be issued by a specialist, usually a dermatologist, for severe cases or to treat an outbreak, according to the UK’s 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 may be because the scabies mite becomes resistant to standard treatments just as the lice that cause the 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 don’t apply them correctly or leave them on long enough, it needs to be at least 12 hours, but many benefit from 24 hours or are re-exposed because they don’t treat those around them.

“We need a national program to overcome this problem… ivermectin is not a bad option if people can’t get anything else.”

Dr. Lucy Pollock, a geriatrician, has witnessed two nursing home outbreaks in the past year, never having seen one before. ‘These are really sad because they cause so much heartache. Scabies is difficult to diagnose in older people because they may have itchy skin for so many reasons,’ said Dr Pollock.

‘Applying creams to everyone twice, including the staff, is not easy. A single tablet might be a more effective approach.’

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