Evidence based choices for first line scabies treatment

Scabies is a common yet neglected ectoparasitic infestation that remains highly endemic in many low and middle income countries owing to crowding and limited access to healthcare,1 and is also increasing in prevalence in several developed settings including Europe.23 The clinical and public health burden of scabies is likely to increase with climate change associated rising global temperatures, migration, and overcrowding.4Scabies causes considerable morbidity through severe itch and rash, with subsequent impacts on education and employment, particularly when there are barriers to diagnosis or appropriate treatment.56 Several topical treatments have been used historically,7 and more recently oral ivermectin has been used in some settings. However, there has been uncertainty regarding the most appropriate first line treatment, particularly because of the lack of previous high quality trials.8To fill this gap, Boralevi and colleagues embarked on the SCRATCH (Scabies Randomised Trial in Children and Adults) study, a rigorous trial that was cluster…