In many developed countries such as Australia, scabies is usually episodic, and is mostly seen
by general medical practitioners, but if either a local outbreak occurs, or the cause of itch is not
diagnosed, it is often dermatologists who are asked to help solve the problem [1]. In a situation
of endemic scabies such as that which occurs in resource poor countries such as Fiji and in some
indigenous communities including in Australia, the problem of scabies is often seen initially by
the primary health care providers, commonly in a public clinic setting [2-4]. If the problem is
recognized as being widespread, it is often passed to the public health authorities to deal with.
At this level it is recognized that the problem of endemic scabies is no longer a purely skin /
dermatological problem any more, but a public health problem.
Consideration has to be given to the effectiveness of treatment of the infected person, their
immediate family and close contacts, as occurs in a situation where scabies is sporadic and
where overcrowding, poverty as well as community caring for children occurs. Easily accessible
water supply, poor sanitation, and a lack of funds to purchase the anti-scabetics for the often
large and extended family are problems, and solving the problem is often seen to be “too hard to
do”.
The low level of research into reducing the scabies infection rate is probably partly due to the
fact that those countries which have endemic scabies are also often the countries where there are
a large number of other health issues to deal with including high maternal mortality, high infant
mortality, HIV infection and tuberculosis.