The HUS region is currently experiencing a scabies epidemic for which medicines are not always effective

According to Katariina Hannula-Jouppi, Head Physician and Head of Skin Diseases, we can already talk about a small-scale scabies epidemic.

“Permethrin cream was previously effective with scabies, but now we often have to also supplement the treatment with oral ivermectin tablets and switch to a different topical treatment, such as sulphur vaseline mixed at pharmacies. The same situation has also been observed elsewhere in Finland,” says Hannula-Jouppi.

Poorly treated scabies is expensive

The effectiveness of permethrin as a scabies medication has decreased, with evidence and experience of this coming from both patients and physicians. There is no undisputed scientific evidence of permethrin resistance. Scabies medications are also very expensive in Finland, which affects their use.

According to Hannula-Jouppi, professionals hope to see ivermectin included in the reimbursement scheme and lower prices for all scabies medications in order to make treatment accessible to everyone.

“Scabies that spreads because of poor treatment resulting from a lack of money represents a significant cost to the health care system, and is also unfair for an individual patient or family. It would be appropriate for society to intervene in this situation,” says Hannula-Jouppi, who also chairs the Finnish Dermatological Society.

How to recognise scabies

Scabies is caused by a mite that is 0.3–0.4 mm long. It burrows small tunnels into the skin, where it lives and lays eggs. Scabies mites usually spread by means of skin contact and shared bed linen.

Scabies already spreads in the asymptomatic phase. This is why other people who may be infected must also be told about the condition. It typically spreads via prolonged contact; between family members and sexual partners, for example.

Symptoms usually appear 3–8 weeks after infection. Scabies causes severe itching, especially in the evenings and at night. Tiny blisters, spots and scratch marks appear on the skin, usually between the fingers, on the wrists, surface of the lower arm, and in the armpit, lower abdominal, ankle and genital areas. The skin may become inflamed due to itching and scratching.

It is essential to repeat the treatment after one week, perform a thorough scabies cleaning after each treatment session, and treat everyone living in the same household at the same time, even if they do not have any symptoms.

How to treat scabies

• When you suspect scabies, you can purchase permethrin cream at a pharmacy without a prescription.
• The treatment should be repeated after approximately one week(the second treatment after 7–10 days), because scabies medications are only effective on living mites. A second treatment session is needed to treat newly hatched mites.
• Everyone who lives in the same household or has been in close contact, such as girlfriends and boyfriends, must be treated at the same time even if they do not have any symptoms.
• Permethrin cream is applied all over the skin in adults, including the scalp and ears, and also on the face of children under 3 years of age. Carefully apply the cream to the inner part of the navel, under the fingernails, between the fingers and toes, to skin folds, the armpits, external genitals and groin area.
• To protect the hands after applying the cream, cotton gloves should be worn and disposable plastic gloves placed over them when using the toilet. If the hands are washed within 12 hours of treatment, the cream must be applied again.
• Permethrin cream should remain on the skin for at least 12–24 hours.
• Scabies treatment should be done in the evening. The next morning or after 24 hours, wash all bed linen, pyjamas and other clothing, take a shower and then wash the towel as well.
• Sulphur vaseline is applied to the skin on three consecutive evenings and left on the skin for 12–24 hours. The treatment is repeated one week later.
• In blended families, both of the children's homes must be treated at the same time.
• According to the recommendation, people should return to their daycare center/work/school no earlier than 24 hours after starting the first treatment or the third application of sulphur vaseline.

Perform a thorough scabies cleaning

• After treatment, perform a thorough scabies cleaning. Medicinal treatment is not sufficient.
• All clothing, towels, bed linen, mattress protectors, blankets and pillows used during the week by people living in the same household must be washed at a temperature of at least 60 degrees Celsius. The same applies to hats, gloves, scarves, head scarves, hijabs and hair ties, baby activity mats, jumping swings and fabric toys, etc. used by all family members.
• Sofas, sofa cushions, upholstered chairs, carpets, seat cushions, car seats etc. are vacuumed thoroughly and, if possible, washed or removed from use for one week. After vacuuming, replace the vacuum bag or clean the vacuum cannister.
• Textiles that are difficult to wash, such as jackets, shoes, blankets, thick mattress toppers, prams and strollers, a baby's car seat, bags, backpacks, hobby equipment and outdoor cushions are removed from use for one week. They can also be placed in a plastic bag overnight at freezing temperatures of at least -18°C or for two hours in a sauna at a temperature of 100°C, with consideration to fire safety.

Report scabies to the school and daycare center

• The school and daycare center must be notified of a scabies infestation. All bed linen, bedtime toys and spare clothes at the daycare center are changed after the treatment with medication.
• Also change into clean work clothes after treatment sessions. Keep nails short and the areas under the nails clean.

Contact primary health care if necessary

• If self-care does not help, request an appointment with primary health care.
• The itching may continue for 2–4 weeks after scabies treatment. This is due to the skin inflammation reaction and dry skin.
• You can soothe the itching with cortisone cream or an antihistamine available without a prescription. You can apply cortisone cream for periods of 2–3 weeks and then twice a week (e.g. Monday and Thursday evening) after this for the same length of time as you applied cortisone cream on a daily basis. Dry skin should be moistened daily with basic lotion.