Job Discussion Forums

[littleleech]

Hi all

I'm looking to get Permethrin cream and possibly Malathion lotion as soon as possible. Have caught a bloody awful (and disgusting) condition/infection called Scabies (no, not sexually transmitted before you start the wisecracks).

Permethrin and Malathion are both purchasable over the counter in the UK, but in Japan, I have no idea. Can anyone attest to what's generally purchasable over the counter in Japan as opposed to in the UK?

I am trying to arrange a doctor's appointment but this always involves a lot of waiting and I need this ASAP. Would appreciate any help with this.

Thanks

[G Cthulhu]

[Bread]

Wait, do you mean you're getting into the doctor just to ask about it, or get a prescription just in case it's needed in Japan, or what? Because "over the counter" means that you don't need a prescription to buy it.

edit: Oh, I get it. You're in Japan now, so there was really no reason for you to talk about the UK at all.

[Glenski]

If you need immediate treatment, go to a doctor immediately. By the time you wait for response on this forum, you will probably have had enough time to do just that.

I don't know if a pharmacist could recommend anything topical or oral to take, but if you absolutely cannot wait a second, give one a try. You should know how to say scabies in Japanese, of course, (kaisen) and how to say you want a cream ("Cream ga hoshi". Or "Cream o kaitain desu" or just ask "Cream ga arimasu ka?"). The word for prescription is "shohosen", so if you can talk about needing or not needing that, it might help.

This research paper says only limited topical creams are accepted by national health insurance.
http://onlinelibrary.wiley.com/doi/10.1111/j.1346-8138.2008.00491.x/pdf
Note the last sentence.
"At present, only topical sulfur preparations and
ivermectin (Stromectol; Merck, Whitehouse Station,
NJ, USA) are covered by health insurance in Japan
when used for treatment of scabies (Table 2). Crotamiton
(Eurax cream 10%; Novartis Pharmaceutical,
Basel, Switerland) is not covered by health insurance
but is often used clinically in the absence of
other effective topical preparations. Benzyl benzoate
and γ-benzene hexachloride (γ-BHC)-containing
topical preparations are made of a combination of
reagents and vehicles, and are used at the responsibility
of physicians in the absence of effective topical
preparations covered by health insurance, although
their efficacy and safety have not yet been fully
evaluated. When using these preparations, it is
necessary to obtain informed consent in writing
from the patient (or his/her legal representative). No
topical permethrin preparation is available in Japan."

Since both medications you know are considered insecticides, don't be surprised if a pharmacist shows some shock if he even knows what you are talking about. Names of medicines will differ from country to country.

More info from the article in case you can't download.
"Sulfur preparation (covered by health insurance)
Sulfur preparation is the only topical preparation
for the treatment of scabies covered by health
insurance. Five to 10 percent sulfur ointment and
thianthol are available for use. Twenty-four hours
after application of ointment, the ointment is washed
off. This sequence of processes is repeated for 5 days.
Toxicity is low and this therapy is applicable also to
pregnant women and small children. The ointment
has odor and skin irritability.
Sulfur-based bathing agents such as 610 Hap
(Mutosho Pharmaceutical, Nagoya, Japan) are commercially
available in Japan. It is advisable to refrain
from using these agents because they are likely to
cause sulfur-associated irritant dermatitis and
asteatotic dermatitis.

Crotamiton (not covered by health insurance but
used without blame)
Crotamiton (Eurax cream 10%) is usually washed off
24 h after its application, and this drug needs to be
applied for approximately 10�14 days. Its efficacy
against scabies is low. It is advisable to avoid
massive use or prolonged use of the drug over wide
areas in pregnant women, infants and children.34
Contact dermatitis may be induced by this drug.

γ-Benzene hexachloride has a problem with soil
retention. In 1971, its production for use as an agrochemical
was discontinued. γ-BHC of 0.5% or 1%
mixed with white petrolatum is applied to the whole
body and washed off 6 h later, as a rule. An emulsifiercontaining
vehicle can stimulate percutaneous
absorption of this drug, and for this reason it is
advisable to avoid the use of such a vehicle.36 When
applying γ-BHC, care is needed to avoid exposure
of the mouth, eyes and so forth to the drug. Topical
application of this drug should preferably be avoided
when skin temperature is high (e.g. immediately
after bathing) or when some other topical preparations
are used simultaneously, to avoid excessive
percutaneous absorption. This drug should not be
used to the areas where the skin barrier has been
disturbed (e.g. erosive skin, ulcerated skin and
areas with secondary infection). As a rule, this drug
is applied for 1�2 cycles, with each cycle consisting
of 1 dose/week.32,33 The maximum single dose is
20 g for adults (200 mg on a γ-BHC basis). Because
this drug exerts efficacy even by a single dose, it has
been used for many patients. Although γ-BHC is
less toxic than the other isomers (α- and β-BHC), it
may be partially converted into more toxic isomers
through absorption and metabolism. The possibility
of this drug to induce central nervous system disorders,
hypoplastic anemia and cancer has also been
reported.37 There is a report that γ-BHC suppressed
the action of γ-aminobutyric acid (GABA) in humans38
and can antagonistically reduce the GABA-like effect
of ivermectin against mites. For this reason, it has
been recommended to place a 3-day or more interval
between treatment with these two drugs.
γ-Benzene hexachloride is the most effective
topical preparation currently available in Japan.

Other topical preparations
Phenothrin (Sumithrin [Dan Healthcare, Tokyo, Japan],
an insecticide of the pyrethroid family) is drug for
control of Phthrirus pubis and Pediculus capitis in
Japan. This drug is very safe and promising as a drug
for topical use for the treatment of scabies. (Note:
Precautions in preparing topical preparations. When
benzyl benzoate or γ-BHC is mixed with a vehicle,
toxicity may be elevated by mixing these drugs with
a highly skin-permeable lotion or hydrophilic vehicle.32
Therefore care is needed when selecting a vehicle
for these drugs. γ-BHC is unstable when the pH is
in the basic range. It has been reported that if mixed
with crotamiton, the chemical stability of the active
ingredient of γ-BHC preparation may decrease over
time.36 Because the vehicle for crotamiton is cream,
its mixture with γ-BHC can stimulate absorption of
the drug via skin.)"

And for what it's worth, here's more info.
http://idsc.nih.go.jp/iasr/22/260/tpc260.html
"Treatment and prevention

Currently used anti-scabies medicines are shown in the Table (see p. 244-245 of this issue). Sulfur-containing preparations are only available drugs approved by health insurance coverage in Japan, but ointment and lotion are only feebly effective and not well accepted. Sulfur-containing bath is to some extent effective, but frequent bathing or high concentration of sulfur might cause roughing of the skin. The current preferable treatment is application of crotamiton ointment. It is important to apply the lotion or the ointment to the whole body from neck to toes, including the hands, fingers and genitals. Since these are only feebly effective and laborious to apply, highly effective oral ivermectin is eagerly desired, and approval of commercialization of such drugs and that of health insurance coverage are expected. For itching, antihistamines are orally administered. "

[littleleech]

Thanks to everyone who replied, especially Glenski with that massive info dump.

If I'm understanding it correctly, it seems to be saying that while generally considered ineffective, Crotamiton lotion is the most common treatment for scabies in Japan?

That's disappointing. Also the last paragraph about Benzene hexachloride USA little confusing - it seems to be saying this is no longer and production and therefore obviously not a treatment?

I would like to just "show up" at my local hospital where I'm registered but in the past I have always gone by appointment and don't even know if just showing up would be an option. There's also explaining the problem once I'm there - by appointment I have a Japanese friend who can help to explain and arrange an appointment but I myself speak very very limited Japanese. It is urgent, really, and all Internet sources say you should see a GP ASAP, but when I've made appointments in the past, it's always meant waiting at least a week. Does anyone have much experience with just showing up at a hospital and trying to get an appointment there and then?

I have looked into an English speaking hospital in Tokyo called St Lukes, but according to the website the first appointment alone is in excess of 20k yen - far too much for a one-time appointment and a treatment that's widely ineffective.

Thanks again.

[Apsara]

Yes, I have showed up at an ordinary hospital (2 different ones) several times and the longest I've ever had to wait was about 2 hours. 30 minutes is more the norm.

Before I was on NHI I used to go to the International Clinic in Roppongi and never waited more than 30 mins there either, and was charged about 12,000 for the appointment and a couple of prescription items. Same at the Tokyo Skin Clinic- you do need an appointment there but you shouldn't have to wait a week, unless the doctors are on one of their trips to the Netherlands for the clinic they do there.

[G Cthulhu]

[Glenski]

littleleech,
Why are you wasting time if this is so urgent? You were the one who wrote that this was needed ASAP.

Just go to a pharmacist or a hospital. Yes, just show up. Go early in the morning. If you have to wait, you wait. It's influenza season, so depending on the type of hospital you visit, you may have to wait in line behind the early rising geriatric crowd, but at least you will have taken care of the urgency you profess.

Since you will probably read this without the time to get in early to the hospital, depending on your schedule, I'd suggest going anytime you can or stopping at a pharmacist/drugstore before/after work. Just go!

Anything else we can tell you here, online pharmacies or recent research articles from the Japanese Dermatological Association or whatever, is pointless. We are not doctors.