Letter to the Editor
Permethrin-resistant scabies
Escabiosis resistente a permetrina
Mar Luque-Luna
, Lluís Corbella-Bagot, Priscila Giavedoni
Corresponding author
Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Binding to voltage-sensitive sodium channels (VSSC) prolongs their depolarisation, causing mite death. Permethrin resistance in several arthropod species has been linked to mutations in the VSSC gene. However, these have not yet been identified in <span class="elsevierStyleItalic">Sarcoptes scabiei</span> var. <span class="elsevierStyleItalic">hominis.</span></p><p id="par0020" class="elsevierStylePara elsevierViewall">Riebenbauer et al.,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> from the Department of Dermatology at the University of Vienna, studied the presence of polymorphisms in domain II of the VSSC gene in <span class="elsevierStyleItalic">Sarcoptes scabiei</span> var. <span class="elsevierStyleItalic">hominis</span> mites from infested patients in order to understand and optimise therapy in permethrin-resistant cases. They studied 67 mites of the species <span class="elsevierStyleItalic">Sarcoptes scabiei</span> var. <span class="elsevierStyleItalic">hominis</span> from 64 infested persons in Vienna, 85.9% of whom were refractory to previous permethrin treatment. They were genotyped (by PCR and Sanger sequencing) for polymorphisms in the VSSC gene and identified in the coding sequence: on the one hand, a transition from guanine to adenosine (G1659A) creating a synonymous nucleotide to the wild-type strain, and subsequently a transversion mutation from adenine to thymine (A1663T) creating a non-synonymous nucleotide, resulting in a non-synonymous substitution from methionine to leucine (M918L) which was detected in 97% of the mites. This change has resulted in resistance in several arthropod species but has not yet been detected in the previously mentioned species.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Subsequent cure of infestation was achieved in 65.6% of participants, predominantly by combination therapy with topical permethrin and systemic ivermectin, with permethrin monotherapy being sufficient to eradicate scabies in 14.6%, in some cases requiring prolonged exposure. This explains why this mutation confers drug tolerance rather than complete resistance.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">They found that the vast majority of this species' mites isolated in Vienna had the M918L mutation, explaining the resistance that this species can exhibit and how it is increasing, as well as a decrease in treatment sensitivity, which is related to treatment failures and increased incidence.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In these cases, they recommend a permethrin exposure of more than 12<span class="elsevierStyleHsp" style=""></span>hours, even for 3 weeks or more, as they found that patients with heavy mite infestation and the mutation needed several weeks of treatment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Dey et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> have recently published a better outcome in patients treated with the combination of permethrin 5% and ivermectin compared to those treated with permethrin alone. Future studies are needed to assess drug-drug interactions, drug resistance and the economic impact of treating with 2 drugs.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have not received any funding for this work.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prescriptions for scabies are rapidly increasing in Spain: an ecological study with national prescription data, 2008-2021" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Martínez-García" 1 => "M. Grau-Pérez" 2 => "A. Buendía-Eisman" 3 => "I. García-Doval" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.18599" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2023" "volumen" => "37" "paginaInicial" => "e346" "paginaFinal" => "e347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36151936" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European guideline for the management of scabies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.M. Salavastru" 1 => "O. Chosidow" 2 => "M.J. Boffa" 3 => "M. Janier" 4 => "G.S. 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Stamm" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2023" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of topical benzyl benzoate vs. oral ivermectin in treating scabies: a randomized study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Meyersburg" 1 => "T. Welponer" 2 => "A. Kaiser" 3 => "S. Selhofer" 4 => "R. Tatarski" 5 => "A. 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