Episode Transcript
[00:00:04] Hello and welcome to a Wonder Care podcast. My name is Sheena Mitchell and I am a pharmacist, mum of three, and here to guide you through all of your family healthcare needs.
[00:00:17] Today's episode might give you a little bit of the heebie GB's, but I always say these things are better to know about, and it's better to be prepared and know what to watch out for than to put your head in the sand and hope that you never hear the word scabies. I'll be explaining scabies and its treatment, but first of all, I want to explain why this is such an important topic right now.
[00:00:44] In 2022 in Ireland, there were nine outbreaks of scabies. In 2023, this had trepled to 27 outbreaks. Now, in reality, there were probably a lot more outbreaks. But the HPSC doesn't collate data on individual cases.
[00:01:03] This problem is not just exclusive to Ireland. There's been an increase in the number of cases of scabies in other european countries too. Why, might you ask, do we need this further horrible problem to worry about? Well, really, it all comes down to supply chain issues. We've all heard about drug shortages for various reasons, to do with the wars going on and the post pandemic ripple effect, and just in general, crisis amongst the pharma world. There's been a rise in the cost of raw materials. And, look, all of this means that it has led to difficulty in community pharmacies sourcing the first line treatment for scabies. Now, it's not that we never have it. Sometimes we do have it in stock, but sometimes it's hard to get. So at the moment, if I go onto my laptop and try and order it into my pharmacy, it's currently unavailable. However, because it's on allocation, sometimes I can get some supply. So it's very hit and miss. And because of these inconsistencies to the supply chain, to the community pharmacies, it means that customers and patients have not been able to just buy lightclear dermal cream when they suspect scabies. That's bad enough, but we actually can't source the second line treatment, which is Derbac M either. And worse, again, the next third line treatment, which is known as benzal benzoate 25% application. This hasn't been available consistently either. Likelier, dermal cream is the only one that's available without prescription, and that's because derbacm and benzol benzoate are both currently unlicensed in Ireland. And so you do require a GP prescription to access them. But in any case, all three have been difficult to get our hands on. The thing about scabies is that it's highly contagious, and once one person in a household gets it, the entire household needs to be treated. And this needs to happen quickly and simultaneously. I find when a health condition has any sort of stigma, which is unwarranted, people are slower to access treatment. I think the only reason that scabies has stigma is because it gives people the heapy cheapies, but it's not associated with hygiene or with anything else. So it's really just horrible, pesky and highly contagious infection with little mites. And so ignoring the problem is definitely not the way forward anyway. Stigma is not the only barrier that exists. As I said, there availability of treatment products has been an ongoing issue. A couple of months could pass without availability. So this means that people who would normally be treating their infection have not been necessarily able to, or they've had to delay treatment until stock became available. And this means that there is greater potential for scabies to spread in our communities. Because of all of this, it's important to be aware of the signs and symptoms and to know and understand that it is highly contagious, particularly in residential settings like nursing homes. But outbreaks can actually also occur in schools, especially during the winter, when people regularly congregate together indoors. Really, it's all about close contact. Okay, so what is scabies?
[00:04:40] Scabies is a skin condition caused by tiny little insects called mites, which burrow under the skin and lay eggs. Lovely. I know these little mites are smaller than a pinhead. They are so small that it's impossible to see them with the naked eye. You can actually have scabies for up to six weeks before you notice any symptoms. Scabies can be passed through any skin to skin contact, and it can actually be passed amongst adults during sex too. And it can affect the genital area. If you do suspect that you have genital scabies, you should also have routine STI tests. The tricky thing about scabies is that they can also live outside of the body for 72 hours and can be passed by sharing clothing, towels and bedsheets. Basically, it's very common and anyone of any age can get it. It's not normally a serious condition as such, but its symptoms can actually make it extremely irritating and it can cause agitation and disrupted sleep. So let's talk more about those symptoms.
[00:05:48] Firstly, people often suffer with intense itching, which gets worse at night. You can also get a raised rash or spots which can be felt so you can feel them on your skin. Because they're raised, the rash often starts between the fingers. Other common areas we see scabies rash in community pharmacy are on the inside of elbows, under your arms, on the feet or ankles, or on the stomach. Sometimes you can see burrow or track marks between the spots on the skin. These can be fine, so very thin and appear silvery in color. The rash is always described as extremely itchy. This itch can feel worse at night or after taking a warm shower. It is usually this intense itching that sets scabies apart from other conditions. If you suspect someone in your household has scabies, you can visit your GP or your community pharmacist. The first line standard treatment, as I mentioned, is lyclear dermal cream. I know I said it's not always available, but do ask your pharmacist as some supplies have been coming in in a trickle, just not as much as needed. We have it available online at Wondercare, ie. But as I mentioned, even I don't always have it in stock. Please note it's not the normal lyclear products used to treat headlice. So it's the lyclear dermal cream that's the one you need. And the most important thing with scabies treatment with likeclear dermal cream is that all the household members, or in the case of adults, sexual partners, must be treated at the same time to prevent reinfection. This applies to everyone in the household from two months of age and up. It's also really important to read the leaflet carefully, as its use is tricky and it has to be done correctly. In general, it needs to be applied to the whole body from the ears down, including and especially in between fingers and in skin creases like the wrists, buttocks, elbows, and even under and around finger and toenails. The cream has to be in contact with the skin for 12 hours, so I recommend applying it at night. And remember to reapply it to your hands if you wash them. It also needs to be reapplied again one week later. One adult will need approximately one tube per treatment. Kids from six to twelve years of age will need approximately half a tube, and for children two months to five years, they'll need about quarter of a tube. So just bear that in mind when you're buying. One tube is not going to do the whole household. And also, if you're buying it, I would probably buy enough to have the reapplication for a week later as well. So, for example, if you've got two adults and an eight year old and a ten year old, you're going to need, for the initial application, one tube for each adult and half a tube for each children. So that's three tubes and you have to redo it in a week. So you're going to need six tubes. So if you're starting treatment, I would definitely recommend picking up all six at once if you can. Some other important advice. Do not apply lyclear cream straight after a hot bath. It's also good to know it can be used safely in pregnancy and it can be also used in breastfeeding. But it is a little bit more tricky because you have to wash it off the breast area before each feed and then you need to reapply it again afterwards.
[00:09:24] Not so easy if you have a young cluster feeding baby, but it's a good idea to try and time the application of the cream so that the 12 hours falls in the time frame where your baby breastfeeds the least. For some people this could be overnight and for some people it may not be. Just something to consider and do. Remember to wash it off first because you don't want the baby to be ingesting it and then after the feed you can just reapply it. So what else can you do when you're treating scabies? It's really important that all bedding and clothing should be washed at a high temperature to destroy mites. Any items which can't be washed in a high heat should be sealed in a plastic bag for 72 hours minimum. For things like teddies that might have been in your kid's bed, it's a good idea to pop them in a plastic bag and pop them in the freezer. It can also work well for shoes, coats, hats, soft toys, that kind of thing. The good news is that adults or children can return to school, crash or work 24 hours after their first treatment. If itching has not subsided within four weeks of treatment or you see new track marks, then you should probably speak to your GP. But do be reassured that even after treatment, itching can persist for a few weeks. It's just. It goes on for longer than four. You do need to go talk to the GP. Watch out for areas of very sore red or hot skin because it is possible for an infection to occur where skin has been broken. If you are experiencing really severe itch, antihistamine tablets and creams can really help to relieve symptoms. So something like ceterazine or laratidine, so there's loads of different brands of these on the market can be really useful.
[00:11:26] Obviously antihist solution or zyotex solution are suitable from two years of age, and if your child is under two and really struggling with the itch, then do talk to the GP because you may be able to get a prescription antihistamine for them. Piritin is another antihistamine and this can be particularly helpful at night. It works for four to 6 hours and it does cause drowsiness. So if your itch is particularly bothering you at night, pyritin is a good idea.
[00:11:56] Other things can help, like using calamine lotion or Urax cream. Urax cream is probably less messy, to be honest, than calamine lotion. Bosch, look at that stage you're going to want to do anything that works.
[00:12:11] If you can't find lyclear dermal cream to treat suspected scabies, please do get in touch with your GP as they might recommend an oral treatment. This is also used off license and again, it's not always available.
[00:12:28] It's no wonder we're having three times more scabies outbreaks than normal. Anyway, I hope this episode helped to make scabies and its treatment more understandable, and I hope it's information that you never need to use. But at least now you'll be able to identify scabies. And if suddenly everyone around you is scratching or sleeping very poorly due to itch, you'll know what it might be. I'll pop a link up to the likelier dermal cream on my instagram at Wondercare Underscore IRL and I'll also pop up a link to the patient information leaflet because it's really important to use this product correctly. If you don't strictly follow the application rules, then unfortunately treatment may not be effective and that is the last thing you want. You don't want to be dealing with this for months and months on end. If you found this episode helpful, please do subscribe to or follow this podcast and even better, leave a review. It really helps for the podcast platforms to see that the podcast is actually useful and therefore to show it to more people. That's it. I'll talk to again soon. Bye.
