Possible local scabies epidemics in Finland – number of diagnosed cases has increased significantly in recent years

In recent years, the number of diagnosed scabies cases in Finland has increased significantly. Last year, there were 37,190 reported cases of scabies in the National Institute for Health and Welfare’s (THL) Register of Primary Health Care Visits (Avohilmo), which is 74 per cent more than in 2022. In 2022, 21,355 cases were reported, which was 85 per cent more than in 2021.

Thus far, 3,610 diagnoses have been reported in Avohilmo this year.

According to Leif Lakoma, Chief Physician at the National Institute for Health and Welfare (THL), there may be local-level scabies epidemics in Finland right now but there is no nationwide epidemic.

"Scabies can cause significant distress and inconvenience, especially in families with children, but fortunately it is something you recover from with no lasting harm. Nevertheless, all cases of scabies should be carefully treated", says Lakoma.

According to him, there have been reports in many European countries of an increase in the number of scabies cases during the last ten years.

"The exact reason for this is unknown. People have always had scabies, and unfortunately we have not found a way to get rid of it completely. The increase in reported cases can be explained in part by an increased awareness of scabies among both patients and the health professionals treating them", says Lakoma.

Scabies mainly treated with one of two products

In Finland, the treatment of scabies mainly consists of one of two products: a permethrin cream that can be obtained without a prescription and prescription ivermectin tablets.

Both treatments should be applied not only to those with symptoms but also to any asymptomatic close contacts, especially those living in the same household or those with whom the diagnosed have had any sexual contact.

Scabies is mainly transmitted from person to person and only survives for a few days outside the body in textiles. However, when undergoing the treatment it is a good idea to wash any clothes, sheets and towels in daily use, and to air out or vacuum all pillows and blankets.

"Permethrin and ivermectin are associated with the lowest number of failed treatments. However, reports of failed treatments have increased in recent years, especially in the case of permethrin. It is unclear why this is happening, but there are no verified reports that the mite responsible for the infestation has grown resistant to the medicines", says Lakoma.

The risk of treatment failure increases especially when not all asymptomatic close contacts are treated at the same time or when the proper cleaning of household textiles is neglected. When ivermectin is used, both the treatment and the cleaning should be repeated after a week, since ivermectin is only partially effective at killing the eggs of the mite.

The National Institute for Health and Welfare’s (THL) website contains more detailed instructions on what to do if a family member is diagnosed with scabies.

Pharmacies can prepare ointment mixtures on doctor’s orders

The Finnish Medicines Agency (Fimea) is responsible for granting marketing authorisations to medicinal products in Finland.

In addition to permethrin and ivermectin, both of which require a marketing authorisation, pharmacies can on doctor's orders prepare sulphur-based ointment mixtures for the treatment of scabies.

Furthermore, Fimea has for special therapeutic reasons granted special permits to certain scabies medicines that have no marketing authorisation in Finland. Special permits can be granted for medical treatment prescribed by a doctor. The responsibility for the safety of the use of any medicine that has not been granted marketing authorisation always lies with the doctor who prescribed it.

There are alternatives to permethrin and ivermectin available in some European countries, but pharmaceutical companies have not introduced these in Finland.

It is forbidden to purchase and receive medicinal products by post from outside the European Economic Area. Within the European Economic Area, medicinal products amounting to a maximum of three months of use may be received by post from a legally operating retailer as long as these products are for personal use. A prescription or medical certificate is needed for prescription medicines. Legally operating online pharmacies may not deliver medicines outside their country of operation.

Lately there has been some public discussion about a certain product meant for treating horses. Whether or not the use of this product by humans is effective or safe has not been studied. When a product meant for animals is used by humans, that constitutes a health hazard.

Basic social assistance may be available for scabies medicines

Scabies has not been classified as a disease according to the Communicable Diseases Act, and thus the medicines are not free of charge.

There has been talk in the media and other forums about the high price of scabies medicines, especially if several packages are needed to treat a family. Currently, neither permethrin nor ivermectin are reimbursable by Kela.

Persons who already have a right to social assistance from Kela can apply for basic social assistance towards their medicine expenses. In such a case, it may be possible for them to get their scabies medicine expenses paid as part of the social assistance.

Whether basic social assistance is granted depends on the applicant’s and their family’s financial situation.

No exact statistics on the number of scabies cases

The scabies cases reported in the National Institute for Health and Welfare’s Avohilmo are cases where a doctor has recorded scabies as one of the diagnosed diseases explaining the reason for the patient’s visit.

When it comes to the cases reported in Avohilmo, it is impossible to determine the start date of the symptoms or how the scabies was diagnosed or if, perhaps, scabies was just suspected but never confirmed.

Furthermore, the first private-sector primary healthcare providers and occupational healthcare providers joined Avohilmo as recently as 2020, and as such the number of diagnoses is not reliable for them.

"In other words, the information is Avohilmo only gives an indication of the number of scabies cases. It is not possible to determine precise numbers based on that", says Lakoma.

Since scabies is not as per Finnish law classified as a communicable disease that needs to be monitored and reported, there is no way to track the number of verified scabies cases.

More information

• Scabies, transmission, symptoms, prevention, treatment (in Finnish)
• Marketing authorisations for medicines (Fimea)
• Special permits (Fimea)
• Ordering medicines online (Fimea)
• Social assistance (Kela)
• Reimbursability by Kela: Pharmaceuticals Pricing Board (Hila)

Leif Lakoma
Chief Physician, National Institute for Health and Welfare (THL)
tel. 029 524 7898
[email protected]

Vesa Mustalammi (marketing authorisations for medicines)
Senior Medical Officer, Fimea
tel. 029 522 3396
[email protected]

Timo Mauriala (special permits for medicines)
Head of Unit, Availability and Laboratory Unit, Fimea
tel. 029 522 3214
[email protected]

Piia Vuorela (classification of medicines)
Director, Safety and Effectiveness area of responsibility
[email protected]

Pasi Pajula
Head of the Centre of Expertise, Kela
tel. 020 634 4218
[email protected]