Pharmacists call for approval of horse de-worming drug ivermectin in war on resurgent scabies

Pharmacists are urging the government to approve the controversial ‘equine wormer’ ivermectin to treat a mite infection of the skin amid reports of rising cases and widespread treatment shortages.

The highly contagious condition, scabies, causes intense itching, raised rashes and spreads easily in close contact with others.

The past year saw a spike in outbreaks, especially among elderly people in care homes and young adults in college. Experts are now warning that some cases are more difficult to treat.

High Street chemists say the main drugs used for the skin condition — over-the-counter creams called permethrin and malathion — are regularly out of stock.

Experts believe that ivermectin – an antiparasitic drug – could be a solution. It is used in veterinary medicine – which is why it is commonly referred to as an equine wormer – and is routinely given to children and adults in mainland Europe and beyond to treat or prevent parasitic infections.

Ivermectin gained notoriety during the Covid pandemic due to claims by fringe medics that it could be a suitable treatment and even an alternative to vaccination, despite a lack of credible evidence.

The drug gained notoriety during the Covid pandemic due to claims by fringe medics that it could be a suitable treatment, and even an alternative to vaccination, despite a lack of credible evidence.

However, only one product containing ivermectin – a cream for skin condition rosacea called Soolantra – is currently approved for use in the UK.

Dr. Leyla Hannbeck, managing director of the Association of Independent Multiple Pharmacies, said: ‘Scabies drugs have been on and off the list of deficiencies for some time now, and we know that ivermectin is a safe and effective treatment. But pharmacists can’t dispense it. A dermatologist can prescribe it ‘off-label’, but a referral takes an enormous amount of time and resources.

“Scabies is a worrying and stressful condition for patients because of its distressing symptoms. They are also likely to pass it on to other people. In the past, the government has issued special protocols in the event of shortages of antibiotics and HRT formulations, which instruct pharmacists on the alternatives they are allowed to use. We need this to be issued now, to prevent further suffering.’

Scabies is caused by the body’s immune response to a tiny mite called Sarcoptes scabiei, as well as its saliva, eggs, and feces. Anyone can be affected, but it mainly affects the elderly, young people and people with weakened immune systems. It is usually spread through frequent or prolonged skin-to-skin contact, and outbreaks usually occur where people live in close proximity.

A ward at an Inverness hospital had to be closed last month after a scabies outbreak, and Norfolk County Council recently wrote to schools to warn teachers to be vigilant for symptoms. On top of a raised red rash, other telltale signs are “spores” under the skin where mites have burrowed. It causes intense itching severe enough to disrupt sleep. This can make the condition worse, leading to bacterial infections.

Guidelines in the UK recommend using permethrin or malathion creams, which should be rubbed all over the body, including under the nails. It should be kept for a maximum of 24 hours and should be repeated after a week.

Alternatively, evidence suggests that ivermectin – taken in pill form – is safe and equally effective. European regulators recommend it in two doses two weeks apart for standard scabies. It can be used alongside the creams for more severe cases.

However, in the UK, a prescription can only be issued by a specialist – usually a dermatologist – for severe cases or to treat an outbreak, according to the UK Health Security Agency.

Dr. Tess McPherson, from the British Association of Dermatologists, said: ‘Dermatologists, especially those who work with young people, feel they are seeing more cases that are more difficult to treat.’

While some studies have suggested that this may be due to the mange mite becoming resistant to standard treatments — just as lice that cause nits are now immune to permethrin — other studies show the drug is still effective.

Dr. McPherson added, “It’s more likely [in cases where treatment doesn’t seem to work] that people don’t apply them properly or leave them on long enough – it should be at least 12 hours, but many benefit from 24 hours – or are re-exposed because they don’t treat those around them.

“We need a nationwide program to get over this… ivermectin isn’t a bad option if people have nowhere else to gain weight.”

Geriatrician Dr Lucy Pollock has seen two outbreaks in care homes in the past year, never before. “These are really sad because they cause so much suffering. Scabies is difficult to diagnose in older people because they can have itchy skin for so many reasons,” said Dr. Pollock.

‘Greasing everyone twice, including the staff, is not easy. A single tablet may be a more effective approach.’