Scabies: Molecular Perspectives and Therapeutic Implications in the Face of Emerging Drug Resistance

Kate E. Mounsey; Deborah C. Holt; James McCarthy; Bart J. Currie; Shelley F. Walton


Future Microbiol. 2008;3(1):57-66. 

In This Article

Abstract and Introduction


Limited effective treatments, coupled with recent observations of emerging drug resistance to oral ivermectin and 5% permethrin, raise concerns regarding the future control of scabies, especially in severe cases and in endemic areas where repeated community treatment programs are in place. There is consequently an urgent need to define molecular mechanisms of drug resistance in scabies mites and to develop and assess alternative therapeutic options, such as tea tree oil, in the event of increasing treatment failure. Molecular studies on scabies mites have, until recently, been restricted; however, recent advances are providing new insights into scabies mite biology and genetic mechanisms underlying drug resistance. These may assist in overcoming many of the current difficulties in monitoring treatment efficacy and allow the development of more sensitive tools for monitoring emerging resistance.


Scabies is an infectious skin disease caused by the burrowing ectoparasitic mite Sarcoptes scabiei. It has remained a health problem for centuries, although its importance is frequently underestimated. The link between streptococcal pyoderma and scabies is being increasingly recognized, with high rates of acute post-streptococcal glomerulonephritis, acute rheumatic fever and rheumatic heart disease observed in Aboriginal communities in northern and central Australia.[1,2] The burden of scabies remains high in these communities despite recent mass-treatment interventions with 5% permethrin.[3,4]

Limited effective treatments are available for scabies. The problem is further exacerbated by difficulties in accurate diagnosis[5] and the increasing threat of acaricide resistance. In this review, therapeutic options for scabies will be briefly outlined, the emergence of drug resistance will be discussed and recent molecular advances will be highlighted.


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