The British Association of Dermatologists (BAD) has issued an alert about an ongoing shortage of scabies medications that it warned could become a "snowballing" public health issue.
The Association called for supply issues to be resolved quickly, describing the UK-wide shortage as being of "great concern", given the highly contagious nature of the condition.
Medicine supply notifications were issued in England, Scotland, and Northern Ireland earlier this month, each stating: "Permethrin 5% w/w cream is in limited supply until further notice due to an increase in demand."
The notifications also all stated that the alternative treatment, malathion liquid, was "currently unavailable". The Department of Health and Social Care (DHSC) said: "These medications are the two main options for treating scabies in the UK, with no alternatives which are widely available, affordable, and effective."
The supply notifications also noted that crotamiton 10% cream (Eurax), which is also licensed for the treatment of scabies, remained available "but can only meet its current demand for other conditions". Although benzyl benzoate 25% topical emulsion could be sourced from special-order manufacturers, it was an unlicensed medicine. Ivermectin 3mg tablets were licensed for treatment of scabies but "are not currently marketed in the UK". Unlicensed supplies may be sourced, but lead times varied.
Surge in Demand Across Europe
Although the notifications were issued in early September, the BAD noted that reports of shortages dated back as far as May. It said it was believed that "a surge in demand for scabies treatments across Europe", together with supply chain issues and increased raw material costs, had all contributed to the shortage.
According to the NHS, most outbreaks of scabies in the UK occur in winter, but precise incidence figures are hard to come by because many people self-treat with non-prescription medicines. Asked to clarify by Medscape News UK, the BAD confirmed that its members were seeing increased cases, with queries coming in to dermatology departments and reported by dermatologists nationally. Precise numbers were not available, but there did seem clear evidence of a rise in cases, it confirmed.
As the topical treatments are the same, it was expected that access to these medications for cases of pubic lice would be equally impacted.
Manufacturers Urged to Increase Production
The BAD urged manufacturers to increase production of medications, noting that the Sarcoptes scabiei mite was easily spread by skin-to-skin contact and outbreaks were common in care homes and group living facilities. In all cases, prompt treatment of those affected — and relevant contacts — was necessary to prevent the mites from spreading.
Dr Mabs Chowdhury, a consultant dermatologist at University Hospital of Wales in Cardiff, and president of the BAD, commented: "The shortage of treatments for scabies is a major public health concern." He said that the ease with which the disease spread highlighted "the urgency of maintaining an adequate supply of effective treatments", and warned it was "not an issue that will just go away".
The Association urged manufacturers of permethrin and malathion "to do everything in their power to increase production". "We also call on regulators, such as the MHRA, and the Government, to give the necessary support to manufacturers and suppliers to enable them rapidly to resolve the issue," Dr Chowdhury said.
Shortage Driven by Increase in Scabies Cases
Asked to comment by Medscape News UK, a DHSC spokesperson said: "We are aware of current difficulties obtaining permethrin 5% cream supply due to an increase in demand for the product." As scabies is not a notifiable disease, and treatment can be supplied over-the-counter, the Department did not have data on this, but was aware that the shortage was being driven by an increase in demand for permethrin due to an increase in scabies cases.
"Manufacturers are continuing to supply it, and we are working with them to ensure that deliveries are expedited and increased where possible," the spokesperson said, noting that it was also aware of manufacturing issues for malathion.
Dr Tess McPherson, consultant dermatologist at Oxford University Hospitals and president of the British Society for Paediatric and Adolescent Dermatology, said: "Scabies disproportionately affects the most vulnerable in society, including young people. It is important to state that you do not get scabies because you are unhygienic, and we must reduce any stigma associated with having scabies so that people do seek treatments when needed. Any reduced access or availability of treatments will have a major impact."