The rising burden of scabies in Italy: insights from a nationwide survey of dermatologists

BACKGROUND: Scabies is an increasingly relevant dermatological and public health issue, with rising case burdens reported in several European countries. OBJECTIVES: To assess Italian dermatologists' perceptions of recent scabies trends and current approaches to diagnosis, treatment, notification, and household-contact management. METHODS: A nationwide cross-sectional online survey was distributed to dermatologists practicing in Italy. The questionnaire investigated perceived epidemiological changes, diagnostic and notification practices, therapeutic choices, ivermectin use, retreatment, household-contact management, and perceived treatment failure. Descriptive, bivariate, and multivariable analyses were performed. RESULTS: Among 308 respondents, 94.2% perceived an increase in scabies cases during the previous 3-5 years, including 73.4% reporting a marked increase; 59.4% indicated that the increase involved all age groups. Clinical evaluation combined with dermoscopy was the most frequently reported diagnostic approach (88.0%), while 79.2% considered diagnosis often delayed. Combined topical and systemic therapy was the most commonly reported first-line approach (56.5%), and 81.8% perceived treatment failures, particularly with topical permethrin, as more frequent than in the past. Among the 306 respondents providing data on household-contact management, 83.3% reported systematically treating cohabitants. Significant differences emerged according to geographical area and workplace setting. In adjusted analyses, private practitioners were less likely to report systematic treatment of household contacts, whereas longer professional experience was associated with greater perception of increasing treatment failure. CONCLUSIONS: Italian dermatologists perceive scabies as an increasingly frequent and clinically challenging condition. These findings support standardized management pathways integrating dermatologists, general practitioners, and public health services, with coordinated household-contact treatment and careful assessment of adherence and reinfestation before therapeutic escalation or attribution of perceived failure to resistance. Objective epidemiological and treatment-outcome studies remain necessary.