Scabies increase during the COVID-19 pandemic: should we change our treatment strategy during the pandemic?

Abstract

Scabies is a highly contagious, parasitic infestation caused by Sarcoptes scabiei var. hominis. There are some reports which claim the incidence of scabies has increased during COVID-19 lockdown. In this study, we aimed to compare the prevalence of scabies between March to September 2020 - the first six months of the COVID-19 outbreak in Turkey - and March to September 2019 - the same period in the previous year. Case number percentages were compared month-over-month and by total numbers for each specified period. Pearson's chi-squared test was the comparison tool used. We checked the records of 36,469 patients who were admitted to Bezmialem Vakif University, Faculty of Medicine, Dermatology Department, a tertiary healthcare center, between March and September 2019, and out of this number, 258 patients had been diagnosed with scabies. The overall scabies case percentage was 0.71% and the range of monthly prevalence was 0.57%-0.83%. During the corresponding period in 2020, 26,219 dermatology patients were admitted, and 465 of those patients were diagnosed with scabies. The overall scabies case percentage was 1.77% and the range of monthly prevalence was 1.37%-3.46%. Scabies prevalence percentages were statistically significantly higher in all months and in the overall total in 2020 (P<0.001). Our nine patients, who admitted in 2020, did not respond to permethrin treatment but responded well to an ivermectin and permethrin combination. Scabies incidence has increased during the COVID-19 pandemic according to our study. We believe there may be an underreported resistance to permethrin and that starting treatment with oral ivermectin in combination with topical permethrin in extraordinary times, such as a pandemic, may help to control outbreaks.