Application errors associated with topical treatment of scabies: an observational study.
Journal
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
ISSN: 1610-0387
Titre abrégé: J Dtsch Dermatol Ges
Pays: Germany
ID NLM: 101164708
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
14
08
2019
accepted:
02
11
2019
pubmed:
30
5
2020
medline:
16
6
2021
entrez:
30
5
2020
Statut:
ppublish
Résumé
In recent years, there has been a significant increase in scabies infestations throughout German-speaking countries. Given the high frequency of treatment failures, the question arises as to whether topical permethrin treatment is always performed correctly. Our department uses a fluorescent test cream to teach patients on how to correctly apply topical permethrin. In the context of a prospective observational study of 21 patients, we systematically assessed and analyzed potential application errors. None of the participants succeeded in adequately applying the cream to the entire skin as previously instructed. The median number of regions left untreated was six (minimum: 2; maximum: 18), which included a median body surface area of 6 % (minimum: 2 %; maximum: 30 %). With regard to predilection sites of scabies, the ankles were left untreated in 62 % of cases, followed by the interdigital spaces (toes) (33 %) and the sacral region (24 %). All patients considered the pretreatment training to be very useful. The present findings clearly demonstrate potential shortcomings when it comes to the application of topical antiscabies treatment. This may provide a (potentially underestimated) explanation for the large number of reports on treatment failures in this regard, which falsely suggest potential treatment resistance.
Sections du résumé
BACKGROUND
BACKGROUND
In recent years, there has been a significant increase in scabies infestations throughout German-speaking countries. Given the high frequency of treatment failures, the question arises as to whether topical permethrin treatment is always performed correctly.
PATIENTS AND METHODS
METHODS
Our department uses a fluorescent test cream to teach patients on how to correctly apply topical permethrin. In the context of a prospective observational study of 21 patients, we systematically assessed and analyzed potential application errors.
RESULTS
RESULTS
None of the participants succeeded in adequately applying the cream to the entire skin as previously instructed. The median number of regions left untreated was six (minimum: 2; maximum: 18), which included a median body surface area of 6 % (minimum: 2 %; maximum: 30 %). With regard to predilection sites of scabies, the ankles were left untreated in 62 % of cases, followed by the interdigital spaces (toes) (33 %) and the sacral region (24 %). All patients considered the pretreatment training to be very useful.
CONCLUSIONS
CONCLUSIONS
The present findings clearly demonstrate potential shortcomings when it comes to the application of topical antiscabies treatment. This may provide a (potentially underestimated) explanation for the large number of reports on treatment failures in this regard, which falsely suggest potential treatment resistance.
Substances chimiques
Insecticides
0
Permethrin
509F88P9SZ
Ivermectin
70288-86-7
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
554-559Informations de copyright
© 2020 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.
Références
Rosumeck S, Nast A, Dressler C. Ivermectin and permethrin for treating scabies. Cochrane Database Syst Rev 2018; 4: CD012994.
Dressler C, Rosumeck S, Sunderkötter C et al. The treatment of scabies. Dtsch Arztebl Int 2016; 113(45): 757-62.
Sunderkötter C, Aebischer A, Neufeld M et al. Zunahme von Skabies in Deutschland und Entwicklung resistenter Krätzemilben? Evidenz und Konsequenz. J Dtsch Dermatol Ges 2019; 17(1): 15-24.
Chinazzo M, Desoubeaux G, Leducq S et al. Prevalence of nail scabies: a French prospective multicenter study. J Pediatr 2018; 197: 154-7.
Veraldi S, Esposito L, Pontini P et al. Where to look for the scabies mite. Infect Dis (Lond) 2017; 49(5): 427-8.
De Sainte Marie B, Mallet S, Gaudy-Marqueste C et al. [Therapeutic failure in scabies: An observational study]. Ann Dermatol Venereol 2016; 143(1): 9-15.
Mellanby K. Transmission of Scabies. Br Med J 1941; 2(4211): 405-6.
Aussy A, Houivet E, Hébert V et al. Risk factors for treatment failure in scabies: a cohort study. Br J Dermatol 2019; 180(4): 888-93.
Khalil S, Abbas O, Kibbi AG, Kurban M. Scabies in the age of increasing drug resistance. PLoS Negl Trop Dis 2017; 11(11): e0005920.
Walton SF, Myerscough MR, Currie BJ. Studies in vitro on the relative efficacy of current acaricides for Sarcoptes scabiei var. hominis. Trans R Soc Trop Med Hyg 2000; 94(1): 92-6.
Ahn CS, Culp L, Huang WW et al. Adherence in dermatology. J Dermatolog Treat 2017; 28(2): 94-103.
Lee IA, Maibach HI. Pharmionics in dermatology: a review of topical medication adherence. Am J Clin Dermatol 2006; 7(4): 231-6.
Snyder A, Farhangian M, Feldman SR. A review of patient adherence to topical therapies for treatment of atopic dermatitis. Cutis 2015; 96(6): 397-401.
Wigger-Alberti W, Maraffio B, Wernli M, Elsner P. Self-application of a protective cream. Pitfalls of occupational skin protection. Arch Dermatol 1997; 133(7): 861-4.
Loesch H, Kaplan DL. Pitfalls in sunscreen application. Arch Dermatol 1994; 130(5): 665-6.
Lynfield YL, Schechter S. Choosing and using a vehicle. J Am Acad Dermatol 1984; 10(1): 56-9.
Fritsch P, Schwarz T. Infektionskrankheiten der Haut. In: Dermatologie Venerologie. Berlin: Springer, 2018: 1164.
Finon A, Desoubeaux G, Nadal M et al. [Scabies of the nail unit in an infant]. Ann Dermatol Venereol 2017; 144(5): 356-61.
Oh S, Vandergriff T. Scabies of the nail unit. Dermatol Online J 2014; 20(10). pii: 13030/qt399489kr.
Tempark T, Lekwuttikarn R, Chatproedprai S, Wananukul S. Nail scabies: an unusual presentation often overlooked and mistreated. J Trop Pediatr 2017; 63(2): 155-9.
Matthias Karasek M, Trautinger F. Österreichweite Kampagne gegen Skabies. J Dtsch Dermatol Ges 2019; 17(9): 983-4.