Frequency of Different Risk Factors in Scabies Treatment Failure

Abstract

Background: Scabies is a highly contagious parasitic skin infestation and an important public health problem, particularly in settings with close contact, overcrowding, and inadequate treatment implementation. Although effective therapies are available, treatment failure remains common and may result from behavioral, household, environmental, and treatment-related factors. Objective: To determine the frequency of different risk factors associated with scabies treatment failure among patients presenting to a dermatology outpatient department. Methods: This questionnaire-based cross-sectional study was conducted at the outpatient Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi, from 1 April 2024 to 1 June 2024. A total of 323 adults with persistent scabies at least three weeks after treatment were enrolled. Treatment failure was clinically assessed and supported by microscopic identification of mites, eggs, or fecal pellets on skin scraping. A structured questionnaire with ten dichotomous items was used to assess patient-related, treatment-related, and environmental or household-related risk factors. Data were analyzed using SPSS version 26 and presented as frequencies and percentages. Results: The most frequent risk factors were absence of written or verbal instructions regarding treatment application (98.5%), failure of all family members to apply treatment simultaneously (90.0%), and lack of understanding of the correct application method (79.6%). Additional factors included failure to repeat treatment (61.3%), not washing clothes and bedding (51.1%), use of other creams instead of prescribed treatment (39.3%), and incomplete or shortened cream application. Conclusion: Scabies treatment failure in this population was predominantly associated with poor patient education, inadequate treatment execution, incomplete household-wide management, and insufficient environmental decontamination.