Scabies on the rise despite contact restrictions

Forum Health Scabies on the rise despite contact restrictions

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    Scabies on the rise despite contact restrictions

    After the introduction of the corona measures, the number of cases of scabies in Germany seemed to be on the decline for a short time. Now, despite contact restrictions, more people are infected with the pathogen again, reports the German Dermatological Society.

    Living close together favors infections

    Scabies, the medical name for scabies, is a highly contagious skin disease that occurs in all age groups. It is transmitted from person to person through skin contact, but an indirect route of infection is also possible. Outside a host, however, the pathogens do not survive longer than 48 hours. Like lice, it spreads well wherever people come together and is not a sign of poor hygiene. The culprit in the disease is the scabies mite, which burrows into the top layer of skin and lays eggs there. Externally, small elongated nodules or protrusions typically develop between the fingers or toes, in the anal fold, in the groin, on the ankle, areola or penile shaft. The immune system reacts to the infection about four weeks later with an itchy rash or eczema.

    Several thousand new cases of scabies a year

    Since the disease is not notifiable, there are no precise figures on the frequency. The responsible health department is only to be informed if scabies spreads in community facilities, for example in old people’s homes, kindergartens or dormitories. Children are most often affected and often have more mites than adolescents or adults. However, despite the uncertainty about the exact incidence, there is some evidence to show the rise in scabies infections. Hospitals reported more scabies patients being admitted to the hospital. In addition, the number of mite-killing drugs prescribed and sold increased. The numbers of individual dermatological clinics also indicate an increase. It is estimated that there are several thousand new patients in Germany each year.

    Different aspects responsible for the increase

    Prof. Dr. med. Sunderkötter, Director of the University Clinic and Polyclinic for Dermatology and Venereology in Halle, explains various interacting factors. Overall, until contact restrictions were put in place, there was an increase in cases of sexually transmitted infections, which include scabies. In addition, an overall increase could favor the fact that the treatment against the mites is often not carried out correctly. Furthermore, similar to Sars-CoV-2, contact persons could be overlooked, whereby the infection spreads further unnoticed. Children in particular are underestimated as a source of infection, as the disease is usually discovered late and then treated inadequately. In addition, they often have close physical contact with other children or caregivers, which promotes the spread of the disease.

    Application error most common reason

    Diagnosing scabies is unfortunately a challenge even for experienced dermatologists. If an infection is diagnosed, drugs must be used to kill the mites, their larvae and eggs. For this, creams for external use on the skin are usually prescribed, most often permethrin. Correct use is crucial: “There is evidence that a lack of therapeutic success is actually the result of incorrect use,” explains Prof. Sunderkötter. Sometimes the exposure time is too short, skin areas are left out or the fingernails are not cut. In addition, all contact persons must be identified and treated as well. Therefore, a detailed explanation by the dermatologist is essential.

    Resistant mites also possible

    Another reason for the increase in scabies cases could be resistance. According to the dermatologist Sunderkötter, the assumptions about permethrin-resistant mites have not yet been confirmed. “However, there are increasingly well-documented and also published cases of insufficient effectiveness of permethrin. Such a decrease in sensitivity would make application errors less forgiving, ”says the expert. Especially since the wrong use of the drugs has been clearly proven. Colleague Professor Dr. med. Peter Elsner also emphasizes the importance of acting quickly: “Even in times of pandemics, people should go to the dermatologist quickly if they notice signs of scabies.”

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Forum Health Scabies on the rise despite contact restrictions