In July 2019, the World Health Organization (WHO) updated its model list of essential medicines to include oral ivermectin for scabies-related infections. This recommendation follows the 2017 WHO categorisation of scabies as a neglected tropical disease. In the UK, scabies outbreaks are a substantial public health burden in care homes for older people. Yet this medicine, endorsed as essential and safe by WHO, remains unlicensed for scabies treatment in the UK.
Standard treatment consists of topical acaricides, applied over the whole body the same day to all residents and staff, left on usually overnight before showering, and repeated seven days later. This process is labour intensive and can be distressing, especially for residents with dementia who might not understand why it is happening.
If you are an elderly person in a care home in Surrey you are unlikely to get [ivermectin]. This needs to changeJo Middleton
Researchers at BSMS published a letter in The Lancet to address this. Jo Middleton, first author on the letter and Research Fellow, Department of Primary Care and Public Health and the NIHR Global Health Unit on Neglected Tropical Diseases at BSMS, says: "The World Health Organization has declared ivermectin an essential medicine for scabies, and it is increasingly used worldwide. For example, we have a PhD student investigating its impact on scabies in remote areas of Ethiopia. Yet in the UK it is still unlicensed, so if you are an elderly person in a care home in Surrey you are unlikely to get it. This needs to change."
Professor Jackie Cassell, Deputy Dean at BSMS, adds: “In our research programme on scabies in care homes, we have seen the considerable distress experienced by frail confused older people who undergo whole body treatments with lotions for scabies. An oral treatment option is essential to reduce the impact of scabies and its treatment in these very vulnerable people”.
Source: Brighton and Sussex Medical School (BSMS)