2023-07-02 19:56:00
SABADELL.– For five months, Ignasi and Helena turned the apartment in Barcelona where they live with Tomás, their son, into a battlefield once morest an exasperating enemy: he Sarcoptes scabieithe mite that causes scabies. The intense itching caused by this ailmentalso called scabies, they may be just the beginning of a fight that can be very long. “The problem is that first they gave us a cream that did nothing. They then prescribed me and Helena some pills that did work, but the boy was only one year old and they said he mightn’t take them. So we had to stick with the cream; first every 15 days, then every Saturday. Each time we had to put it on ourselves, supposedly to avoid catching it once more, and wash all our clothes. We ended up completely obsessed”, recalls the couple.
The family slept in the fall of 2021 with regarding thirty friends in a large rented house in the countryside. Although they do not know for sure, they suspect that the infection occurred there, which occurs when the skin comes into contact with that of a carrier or contaminated clothing. With tens or hundreds of thousands of cases a year like those of Ignasi and Helena – there are no official data, since the disease is not mandatory to report -, scabies became a public health problem in Spain. This is the unanimous opinion of all the experts, who insist that the disease went from being something exceptional to becoming a very common diagnosis in consultations following an explosion of cases registered in recent years.
Medicine still does not have a conclusive explanation for this increase, but a growing number of doctors think that a new variant of the parasite resistant to permethrin – the cream treatment given first to those affected – is behind the huge increase of infections. Others, however, focus on the fact that many patients administer these creams incorrectly, which causes them not to heal. The problem, in any case, reached such proportions that the health system began to review its protocols to deal with the disease.
“We have not stopped seeing scabies for two or three years. There is talk of resistance, but I think it has more to do with the misuse of treatments. The cream must be applied well, all over the body, and let it act. And they all have to do it at home, because this is a shared disease. If someone doesn’t do it, it happens like lice: following a short time everyone has it once more. And we must not forget to wash all the clothes well, the sofa covers… ”, he explains Francisca Gómez Molledafamily doctor at the Dobra Health Center, in Torrelavega (Cantabria).
The scabies parasite burrows tunnels into the skin, lays eggs, but you don’t feel itchy until your immune system reactsDonyaHHI – Shutterstock
Cristina Galvan She is a member of the Spanish Academy of Dermatology and Venereology and Vice President of the International Alliance for Scabies Control (IACS). “The problem is that, at first, scabies does not itch. If I have it and live with you, the normal thing is that it infects you. But for the first four or six weeks you won’t notice anything at all. The parasite will dig its tunnels in the skin, it will lay eggs, but you will not feel itchy until the reaction of the immune system occurs following that time ”, he explains.
This delay is, according to experts, key to the difficult control of outbreaks. “What sometimes happens is that only those who are itchy are treated well. Others think they are fine and that they don’t need it. In the end They end up having scabies just the same, but by the time they notice it, they’re infecting others once more. And it never ends like that”, adds Galván. For this specialist, with the available evidence, it is not possible to conclude that the parasite developed resistance to permethrin: “Sensitivity studies do not show it, although it is something that must be further investigated.”
Miquel Casalshead of pediatric dermatology at Park Taulí Hospital in Sabadell (Barcelona), has a different opinion and considers the loss of effectiveness of permethrin to be key. “There are patients who received five and six cycles of this treatment and the response is not what it was before, many primary care doctors repeat to us. It seems clear that we are facing a resistance problem”, he affirms. According to this specialist, “the phenomenon is so recent that it has not yet been fully included in the scientific literature, although some publications already point to it.” Casals explains that Meetings have already begun to be held to review the protocols once morest the disease.
Ana Pulido, a dermatologist at the Gregorio Marañón Hospital (Madrid), also considers that there is beginning to be “certain scientific evidence that suggests the development of resistance mechanisms” by the parasite. This, in her opinion, “forces to reconsider the treatment regimen” with the use of “oral ivermectin and other topical alternatives such as sulfur-containing Vaseline” in patients who “do not improve despite correctly carrying out the therapeutic advice”.
The data on the sale of medicines once morest scabies, provided by Iqvia, illustrates the great changes that have occurred in the last five years. In 2017, slightly less than 15,000 pots of Perme-Cure or Sarcop, the two brands of permethrin creams, and regarding 3,000 of Soolantra, another less used cream that contains ivermectin, were sold in Spain per month. At that time, there was no brand of pills with this second active principle for sale in pharmacies. Vaseline with sulfur is not for sale in commercial presentations and is prepared as a magisterial formulation.
Miquel Casals, head of pediatric dermatology at Hospital Parc Taulí in Sabadell (Barcelona), considers the loss of effectiveness of permethrin to be key
Last year, sales of permethrin creams had skyrocketed to more than 66,000 a month (4.4 times more), Soolantra to 6,300 (2.1 times more) and ivermectin pills to almost 50,000 a month following the Ivergalen will go on the market in May 2021 and Ivercare in April 2022. The turnover of these treatments, which require a prescription and are financed by public health, increased eightfold, going from around 3,000,000 euros per year to regarding 25,000,000.
The sulfur vaseline returned peace to the house of Ignasi, Helena and Tomás. “We had to insist a lot because the dermatologist told us that we were the ones who were not doing the permethrin treatment well. But the end was given to us at the Hospital de la Vall d’Hebron. We put it on and in two or three weeks we managed to return to normal”, he assures.
Helena summarizes the routines and changes that scabies imposed on them: “Every day we made a washing machine with the bedding and towels. On Saturdays we smeared each other with the cream. It was also the day to clean the duvets and the clothes that we had been putting in plastic bags during the week. Everything at 60 degrees and ironing conscientiously, ”she recalls.
At first, Ignasi would go down to the neighborhood laundry to wash the quilts and bulkier clothes and use the dryer. But then he began to suspect that the temperature reached there did not kill the parasite, so the couple bought a washer-dryer. They laminated the sofa and everything that mightn’t be exiled to the terrace, where they took a good part of the apartment’s furniture. Tomás, who was one year old at the time, had to stop going to daycare so as not to infect the other children. This forced Helena, an employee in a family business, to telework to be with him, while Ignasi continued as she might with her work as a freelance photographer. “It was a real nightmare. You end up living with the bare minimum, believing that the parasite can be anywhere. It is an experience that I would not wish on my worst enemy”, he concludes.
By Oriol Güell
EL PAISConocé The Trust Project
1688349184
#explosion #cases #scabies #European #country #warns #resistance #parasite #usual #treatments
