Scabies emergency: drug resistance, high costs and increasingly ineffective treatments in Italia
Scabies is a socially relevant disease that has also flared up in our country, but despite this no medication used for its treatment is still provided free of charge by the National Health Service
by Fabio Arcangeli *
In 2017, the World Health Organisation listed scabies as a neglected tropical disease, recognising its significant impact on public health. In recent years, due to intense migratory flows, tourism in countries with a high risk of parasitosis, drug resistance, improper or evaded treatment and its cyclical evolution, it has become more frequent, even in Italia, with a real boom in 2024 and an overall increase of up to 750% compared to pre-Covid levels, in some regions such as Lazio and Emilia-Romagna.
Social Impact
Scabies is a disease of social importance, subject to compulsory notification and often to home checks by the Hygiene and Public Health Services but, despite this, no medication used for its treatment is provided free of charge by the National Health Service.
The most recent international guidelines indicate for the treatment of scabies the application of Permethrin 5% cream or the oral intake of Ivermectin at a dose of 0.2 mg/kg body weight.
Treatment costs
The costs of an effective therapy for one patient and for each close contact (family member or cohabitant) would amount, for a local treatment with permethrin, to about EUR 138 for a child and EUR 276 for an adult, for an oral treatment with ivermectin, to about EUR 80 to 240, depending on the weight of the person. For a household consisting of a child and two adults, the expenditure could be around EUR 700 in the case of only local treatment with permethrin and around EUR 560 in the case of treatment with ivermectin.
Not only resistance to permethrin, but also poor therapeutic management, involving treatment that is not carried out due to high cost, insufficient dosage indications, failure or inadequate treatment of close contacts, may contribute to the increasing spread of the parasitosis. This is why scabies drugs should be dispensed free of charge throughout the country (this is currently only the case in a few regions, such as Emilia-Romagna and Trentino-Alto Adige, but following dosage indications that are sometimes insufficient), recognised in band A, so that they are easily accessible to all and can be used for the right duration of treatment, at the discretion of the prescribing doctor, since there are specific situations in which it may be necessary to prolong or intensify therapy.
Towards new recommendations
Together with the presidents of the main Italian dermatological and paediatric scientific societies, we met in Rome in the Senate: this gave rise to a commitment to produce updated therapeutic recommendations in a short time, which could be more effective in stemming the growing spread of this parasitosis of major social importance.
