title: [Therapeutic failure in scabies: An observational study].
abstract: BACKGROUND
  Several sources suggest an escalation of scabies in France.
  
  
  OBJECTIVE
  To describe a population of patients continuing to present with scabies despite multiple treatments in order to identify factors associated with persistence of infection.
  
  
  METHODS
  A descriptive cross-sectional study in adults and children consulting for persistent scabies despite at least one previous treatment. A standardized questionnaire explored potential sources of treatment failure.
  
  
  RESULTS
  Thirty-one patients were analyzed. Initial symptoms were noted to have started between two and 52 weeks earlier (mean: 19 weeks). The mean number of prior consultations with a general practitioner was 3.1 (0-10) and 1.7 with a dermatologist (0-7). The mean number of patients per household was 3.5 (1-9). At least one dose of oral ivermectin (maximum of 6 doses per household) was prescribed for 84 % of patients (29 % of whom were not fasted at the time). Further, 74 % of patients received at least one local application of esdepallethrin and piperonyl butoxide (maximum: 5 courses), four received benzyl benzoate and two received permethrin; however, 58 % did not reapply the substance after hand washing. All households bought the prescribed treatments despite the costs. Close contacts of patients were treated in 58 % of households. Decontamination of bedding and clothing was carried out properly in 90 % of households.
  
  
  CONCLUSIONS
  Persistence of infection appears to be linked to: (1) insufficient treatment of close contacts; (2) absence of a second treatment between days 7 and 14; (3) insufficient efficacy of the available treatments, doubtless due to multiple factors (intrinsic resistance of Sarcoptes, failure to repeat treatment, poor explanation of methods for dosing and application, and oral intake of treatments). Access to non-reimbursed treatments was not identified as a problem and decontamination of bedding and clothing was correctly performed in most cases.
  
  
  CONCLUSIONS
  Though certain fundamental aspects of scabies treatment must be better known, longer consultations and provision of efficacious treatments are also a priority.
authors.affiliation: UMR 911, Inserm CRO2, centre de recherche en oncologie biologique et oncopharmacologie, service de dermatologie, hôpital Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, 264, rue Saint-Pierre, 13385 Marseille, France.
authors.forename: B
authors.initials: B
authors.lastname: De Sainte Marie
authors.affiliation: UMR 911, Inserm CRO2, centre de recherche en oncologie biologique et oncopharmacologie, service de dermatologie, hôpital Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, 264, rue Saint-Pierre, 13385 Marseille, France. Electronic address: stephanie.mallet@ap-hm.fr.
authors.forename: S
authors.initials: S
authors.lastname: Mallet
authors.affiliation: UMR 911, Inserm CRO2, centre de recherche en oncologie biologique et oncopharmacologie, service de dermatologie, hôpital Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, 264, rue Saint-Pierre, 13385 Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Gaudy-Marqueste
authors.affiliation: Unité d'aide méthodologique à la recherche clinique, Assistance publique-Hôpitaux de Marseille, Marseille, France; EA 3279 « Qualité de vie concepts, usages et limites, déterminants », Aix-Marseille université, Marseille, France.
authors.forename: K
authors.initials: K
authors.lastname: Baumstarck
authors.affiliation: UMR 911, Inserm CRO2, centre de recherche en oncologie biologique et oncopharmacologie, service de dermatologie, hôpital Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, 264, rue Saint-Pierre, 13385 Marseille, France.
authors.forename: N
authors.initials: N
authors.lastname: Bentaleb
authors.affiliation: Unité d'aide méthodologique à la recherche clinique, Assistance publique-Hôpitaux de Marseille, Marseille, France; EA 3279 « Qualité de vie concepts, usages et limites, déterminants », Aix-Marseille université, Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Loundou
authors.affiliation: UMR 911, Inserm CRO2, centre de recherche en oncologie biologique et oncopharmacologie, service de dermatologie, hôpital Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, 264, rue Saint-Pierre, 13385 Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Hesse
authors.affiliation: UMR 911, Inserm CRO2, centre de recherche en oncologie biologique et oncopharmacologie, service de dermatologie, hôpital Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, 264, rue Saint-Pierre, 13385 Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Monestier
authors.affiliation: UMR 911, Inserm CRO2, centre de recherche en oncologie biologique et oncopharmacologie, service de dermatologie, hôpital Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, 264, rue Saint-Pierre, 13385 Marseille, France.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Grob
authors.affiliation: UMR 911, Inserm CRO2, centre de recherche en oncologie biologique et oncopharmacologie, service de dermatologie, hôpital Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, 264, rue Saint-Pierre, 13385 Marseille, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Richard
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000487:Allethrins / Q000627:therapeutic use; D000977:Antiparasitic Agents / Q000627:therapeutic use; D001565:Benzoates / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003666:Decontamination; D003880:Dermatology / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D058006:General Practice / Q000706:statistics & numerical data; D006235:Hand Disinfection; D006801:Humans; D007223:Infant; D007559:Ivermectin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D026023:Permethrin / Q000627:therapeutic use; D012532:Scabies / Q000188:drug therapy* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000487:Allethrins; D000977:Antiparasitic Agents; D001565:Benzoates; D026023:Permethrin; D007559:Ivermectin; C006723:benzyl benzoate
keywords: Anti-scabies treatment; Gale; Ivermectin; Ivermectine; Scabicid; Scabies; Scabécide; Therapeutic failure; Traitement anti-scabieux; Échec thérapeutique