Therapeutic Advances, Diagnostic Innovations, and Strategic Priorities for Global Scabies Control: An Integrative Review

Abstract

Scabies, caused by the mite Sarcoptes scabiei var. hominis, remains a widespread dermatological and public health concern, especially in low-resource settings where overcrowding and limited healthcare access are prevalent. Despite being curable, the disease is under-recognized and often complicated by bacterial superinfections, contributing to significant morbidity. This review critically explores the progression of scabies treatment, from conventional topical therapies such as permethrin and sulfur to systemic regimens like ivermectin and combination protocols for crusted scabies. New pharmacologic candidates—spinosad, moxidectin, and fluralaner—offer promising alternatives but require further study in vulnerable populations. Concurrently, diagnostic approaches are transitioning from subjective clinical assessments to enhanced technologies such as dermoscopy, AI-assisted image analysis, and portable microscopy, improving case detection and operational scalability. Mass drug administration (MDA) initiatives have reduced prevalence in several endemic regions but face implementation barriers, including resistance development, contraindications in key populations, and health system limitations. Persistent gaps in drug efficacy surveillance, diagnostic infrastructure, and research inclusivity impede sustainable progress. The review emphasizes the need for integrated, equity-focused strategies—combining therapeutic innovation, diagnostic reform, and policy alignment—to move toward effective and enduring global scabies control.