H20 Sarcoptes scabiei: to solve the current crisis, hunt for clues in our past
Authors: Nikookam Yasmin , Malik Nabiah , Hirniak Johnathan , Guckian Jonathan 
Published: June 2024

A recent surge in scabies infections has risen to epidemic levels, amid an acute shortage of treatments, coupled with concerns regarding potential rising resistance of Sarcoptes scabiei to first-line treatment. This is a public health crisis. Scabies has subsequently been added to the World Health Organization’s list of neglected tropical diseases. Clues to solve the current crisis may lie in the history of this mite and its relationship with dermatology. Scabies, a parasitic infestation caused by the S. scabiei mite, has been a persistent challenge throughout the annals of dermatological history. This retrospective study traces the evolution of scabies treatment from ancient remedies to contemporary therapeutic modalities. The earliest documented treatments, rooted in ancient civilizations, range from herbal concoctions and topical ointments to ritualistic practices. Throughout the Middle Ages, a mixture of folklore and early medical observations led to diverse concoctions incorporating sulfur and mercury. The Renaissance marked a period of increased scientific inquiry, with the identification of the scabies mite itself by the Italian physician Giovanni Cosimo Bonomo and his assistant Diacinto Cestoni in 1687. Advancements in parasitology during the 19th and early 20th centuries led to a more precise understanding of scabies’ transmission and life cycle. This period introduced various topical treatments, including benzyl benzoate, which has remained prominent since. The mid-20th century brought about the discovery of insecticides like lindane and permethrin, revolutionizing scabies therapy. Buxton’s work discussing the prevention and treatment of scabies during the 1900s, when scabies was on the rise, highlighted the importance of hygiene, prevention, seasonality and public health measures. He advocated for effective disinfection of bedding and clothing, and education on the disease and preparations used to eradicate scabies. However, concerns over resistance and side-effects have prompted a shift towards safer and more efficacious treatments in the late 20th century. Ivermectin, an antiparasitic medication with broad-spectrum activity, emerged as a significant breakthrough, offering an oral alternative to traditional topical therapies. The 21st century witnessed ongoing research into novel therapeutic agents, including newer topical acaricides and investigational drugs. This historical exploration highlights the evolution of scabies’ treatment through time with advancing medical understanding. As we experience permethrin shortages, dermatologists are seeking to find alternative approaches to address this public health issue – in which we can hunt for clues in our past. Dermatologists should ensure that patients are equipped with an understanding of disease transmission and prevention strategies, and consider sulfur-based products. A recent study demonstrated that sulfur 10% ointment was significantly more effective in treating scabies than permethrin 5% cream, highlighting how we may learn from our ancestorial practices.