Scabies treatment shortage raises concerns about public health

As reported by The Pharmaceutical Journal, The British Association of Dermatologists has issued a warning about a potential public health crisis as the supply of scabies treatment cream becomes limited, prompting concerns about the impact on vulnerable populations and the need for urgent action from manufacturers and health authorities

A medicine supply notification, issued by the Department of Health and Social Care (DHSC) on 8 September 2023, said that permethrin 5% w/w cream (Sandoz) would be “in limited supply until further notice due to an increase in demand”.

The notification also warned that malathion liquid, an alternative to permethrin for the treatment of scabies, was currently unavailable, adding that crotamiton 10% cream (Eurex; Thornton & Ross), which is licensed for the treatment of scabies, remains available “but can only meet its current demand for other conditions”.

According to the notification, ivermectin 3mg tablets are licensed for the treatment of scabies but are not marketed in the UK. Unlicensed supplies of the product are available, as is benzyl benzoate 25% topical emulsion, which is also unlicensed but can be sourced from special-order manufacturers.

Scabies is a parasitic infestation caused by mites. The contagious skin condition can lead to sores and serious complications, including septicaemia, heart disease and kidney problems.

Commenting on the shortage, Mabs Chowdhury, president of the British Association of Dermatologists, said: “We are aware of an increasing number of scabies cases being reported in the UK. Given this situation, if supplies of standard topical treatments, such as 5% permethrin cream, are unavailable for treating this debilitating and intensely itchy skin condition, then this is likely to become a major public health issue.

He added that scabies commonly affects young children and adolescents and it is often associated with vulnerable adults, with outbreaks common in care homes and similar facilities.

“We urge manufacturers of permethrin and other widely used topical treatments for scabies, such as malathion, to urgently increase production to avert potential shortages in the UK.

“Unfortunately, alternatives are either unavailable or are unlicensed and very expensive,” Chowdhury said.

Suraj Shah, drug tariff and reimbursement manager at Community Pharmacy England, said supply of permethrin cream has been subject to supply disruption for several months, exacerbated by several localised scabies outbreaks.

“Whilst the DHSC issuing a medicine supply notification is a positive step, it comes much later than we would have hoped,” he said.

“Unfortunately, we expect that fulfilling prescriptions will remain a challenge as alternative products may struggle to meet demand or require prescribers to amend prescriptions, and local discussions may be required to ensure patients can access treatment in a timely manner.”

Shah added that ongoing medicine supply issues were causing pharmacy teams to spend additional time sourcing medicines, contacting prescribers to issue replacement prescription for other available alternatives, and explaining reasons for delays in supply to concerned patients and carers.

“We have been pressing the DHSC to think broadly about what measures could help to manage the mounting medicine supply problems and consider the introduction of greater flexibilities, such as allowing pharmacists more professional discretion to give alternative formulations such as unlicensed preparations.

“We have also been clear that more communications are needed to reassure patients and to protect pharmacy staff from the abuse that they are reporting,” he said.