LAUSR

Dear Editor, Over the last decade, a rising incidence of scabies in Europe1,2 has been reported. However, making an accurate estimation of the prevalence of this disease is challenging, given that scabies is not a notifiable disease in most European countries, as occurs in Spain. The lack of reliable epidemiological data, along with many physicians' perception of an increasing frequency of scabies consultations motivated this study. Permethrin 5% cream is considered the first treatment of choice for scabies3 and is approved only for scabies in Spain. Therefore, assessing the evolution of national prescriptions over time could give an approximation to the evolution of the incidence of scabies in the country. For this study, we used permethrin 5% cream prescription data across Spain between 2008 and 2021. Data were provided by the Spanish Ministry of Health and corresponded to all prescriptions made within Spain's public healthcare system, which represents at least 83.4% of all health care.4 The number of prescriptions per 100,000 population for each year (prescription rate) was calculated by dividing the total number of prescriptions of each year by the midyear Spanish population of the corresponding year.5 We then used joinpoint regression program (Version 4.9.0.1) to evaluate the annual percentage change (APC) in the prescription rate of permethrin cream. Between 2008 and 2021, the number of prescriptions of permethrin 5% cream per 100,000 population steadily increased in Spain, going from 111.14 in 2008 up to 708.19 in 2021 (Figure 1). We found evidence of three tendencies in the study period: an initial mild but steady increase of 2.9% between 2008 and 2013 (p = 0.01), then a higher APC of 17.8% between 2013 and 2019 (p < 0.001) and a final steeper increase with an APC of 39.7% between 2019 and 2021 (p < 0.001). We present recent information on national prescriptions of permethrin in Spain from 2008 to 2021. Our results show a sustained rising trend in prescriptions of permethrin 5% cream since 2008, which stepped up from 2013 onwards and peaked in 2020– 2021 amidst the SARSCoV2 pandemic, suggesting a scabies outbreak might be striking Spain. Considering that this cream is only indicated for the treatment of scabies, it is reasonable to assume that these data reflect an increase in the number of clinical diagnoses of Received: 15 June 2022 | Accepted: 14 September 2022