The parasite on the agenda: Scabies

SCABIES PILLS ARE NOW COVERED BY REIMBURSEMENT

Scabies cases, which have increased to alarming rates in Turkey in recent years, have become one of the most common conditions seen in dermatology clinics over the last few years. A new era has begun in the treatment of scabies, which both patients and physicians have struggled to manage in the region, especially following the February 6 earthquakes.

Oral pills, which were introduced to the market in Turkey about 1.5 years ago, facilitated patient treatment and daily life but were not covered by the Social Security Institution (SGK). While patients who could not afford the medication costs, which reached 1,000 liras per month, tried to make their voices heard through campaigns, professional associations were also demanding that the new generation of drugs developed against the disease, which has become a significant public health issue, be included in the reimbursement scope.

These efforts finally yielded results, and two separate drugs with the active ingredient Ivermectin have been added to the SGK's reimbursement list. If prescribed by a doctor, patients can now access scabies pills free of charge.

INCREASED 30-FOLD BETWEEN 2017 – 2019

Scabies is a disease that causes outbreaks in certain periods all over the world. Some creams and mixtures frequently used in treatment can sometimes be ineffective. Furthermore, conditions such as including the entire family in the treatment, the patient bathing during this process, and washing clothes and bedsheets at high temperatures make treatment compliance difficult.

In a statement made last year, the Turkish Society of Dermatology pointed out that there was a major increase in scabies cases in the earthquake zone, particularly in Hatay, and emphasized that pills could be used for patients if there were no suitable bathing facilities in communal living environments during treatment. Association members had warned, “Previously, there were no pills used for scabies in our country. However, although this drug has recently become available in our country, it is only possible to obtain it for a fee. Our demand is that these drugs be included in the SGK scope without delay and that our citizens, especially those in the earthquake zone, benefit from this medication.”

SEEN AS AN EPIDEMIC FOR 5 – 6 YEARS

Important data were shared and remarkable statements were included in the Turkish Society of Dermatology's announcement.

It was stated that scabies cases in Turkey had increased by 30 percent compared to the previous year (2022); irregular migration, the pandemic, the attempt to examine patients in a limited time, and the fact that people had to live in communal settings following the February 6 earthquakes and could not meet the water needs required for hygiene were cited as the reasons for the increase in scabies.

In the statement, it was said: “Twenty years ago, when we saw a scabies patient, we would say ‘Does scabies still exist?’ and we would be very surprised. Scabies, which we could say was almost non-existent in Turkey at that time, has been in the form of an epidemic in our country for the last 5-6 years. We started seeing 3-5 patients a day. It is stated that in some hospitals, scabies accounts for 30-40 percent of patients applying to dermatologists. Studies conducted in our country reported that scabies cases increased approximately 7-fold in 2018 compared to 2017, and showed a 30-fold increase when 2017 and 2019 were compared.”

The Ministry of Health, on the other hand, responded to these and similar statements by saying, “There is no increase or epidemic that would cause concern.”

THE ACTUAL NUMBER OF CASES IS FAR ABOVE THOSE DETECTED

However, data included in the Scabies Diagnosis and Treatment Guide prepared by the Turkish Society of Dermatology also emphasized that 17,803 (14,574 adults and 3,229 children) patients were diagnosed with scabies between 2014 and 2019, and a study covering the years 2016–2019 at two separate tertiary hospitals in Istanbul highlighted that a scabies epidemic began in the last quarter of 2018 and continued in 2019 in Turkey.

In a cross-sectional study conducted in 2021, it was reported that the prevalence of scabies was 10.9 percent, but it was stated that when unregistered cases are also taken into account, it is estimated that the actual numbers are far above those detected.

“WE HAVE STARTED TO MANAGE THE DISEASE MORE EASILY”

Assoc. Prof. Dr. Aslan Yürekli from the Dermatology Department of Muğla Training and Research Hospital evaluated the inclusion of the two drugs in the reimbursement scope as an important development resulting from the efforts of the Turkish Society of Dermatology as well as the initiatives of the patients. Stating, “This has been a development that has greatly relieved and strengthened our hands,” Assoc. Prof. Dr. Yürekli said, “Our patients have been able to access oral medications free of charge for a month, in addition to topical drugs. With these drugs, we have started to manage the disease more easily. The situation where we had to check whether patients had the purchasing power to buy the drugs has been eliminated.”

INCREASED PATIENT COMFORT

Assoc. Prof. Dr. Aslan Yürekli stated that oral tablets can be used in every case, but that the SGK recommends them primarily for patients who use topical drugs but do not benefit from them. Explaining the importance of patient compliance with topical drugs, Assoc. Prof. Dr. Yürekli said:

“The topical drugs used in scabies treatment must be used correctly and regularly. There is no such problem with oral medications, so it has increased patient comfort.

We can say that scabies cases have increased quite a bit recently, but we have started to break this after the pills were included in the reimbursement scope. Our hands are stronger now, and I can say that the number of cases has started to decrease.

During the period when scabies cases were rising, we were detecting it in 30 out of every 100 patients. Currently, 4–5 out of every hundred patients are diagnosed with scabies. I believe that applications to dermatology clinics will decrease rapidly.”

NOT GIVEN TO PREGNANT WOMEN AND CHILDREN UNDER 15 KILOS

New drugs with the active ingredient Ivermectin can also be used in children. The only condition is to be over 15 kilos. The drug is not used for pregnant women, breastfeeding mothers, and those with liver failure.

Oral treatment can be administered in two courses with a one-week interval. One course is adjusted as one tablet per 15 kilos. That is, if the patient is 60 kilos, they take 4 tablets. If necessary, the treatment can be repeated the following week.