Introduction Scabies is a widespread, contagious parasitic disease causing intense itching. Its detection is a significant problem while there are no internationally agreed standards. Aim To compare diagnostic methods: microscopy of skin scrapings, dermoscopy, and real-time polymerase chain reaction (PCR) of skin scrapings and wet skin swabs. Material and methods We included patients with clinical signs of scabies. After dermoscopic evaluation, scrapings were collected from skin lesions and assessed by light microscopy and real-time PCR. Wet skin swabs were also analysed by real-time PCR. Surveys on the presence and severity of pruritus and skin lesions were collected. Seventy-five skin scrapings and 41 wet swabs were examined by real-time PCR. Fifty-three patients completed the survey. All patients underwent dermoscopy and microscopy examinations. 6.67% were positive by microscopy, 10.7% by dermoscopy, 28.0% by real-time PCR from scrapings, and 36.6% when both scrapings and swabs were examined by real-time PCR. All microscopy-positive results were also positive by PCR. Results There was a correlation between real-time PCR from positive scrapings and pruritus ( p = 0.023) and body surface area of lesions ( p = 0.002), a correlation between copies from wet skin swabs and BSA of lesions ( p = 0.002) in the whole group, and a correlation between copies of S. scabiei from scrapings and age ( p = 0.038). Conclusions Real-time PCR testing of scrapings and dermoscopy are more effective than microscopy. Combined real-time PCR testing of scrapings and skin swabs seemed the most effective. Clinical signs alone should not be used as unambiguous criteria.
Scabies is a widespread, contagious parasitic disease that affects all socioeconomic groups and was added to the list of WHO Neglected Tropical Diseases. Recent studies indicate misdiagnosis in 45% of patients with scabies. Crusted scabies is a rare, acute and highly contagious form of scabies infestation, mainly observed in patients with immunosuppression or mental illness. Standard therapy for crusted scabies is a combination of a topical scabicide and oral ivermectin. The aim of the study was to present the case of a 19-year-old male patient with Down syndrome and systemic disorders, who was diagnosed with crusted scabies and successfully treated with ivermectin. We suggest that ivermectin is an effective and safe therapy for crusted scabies treatment. The presented case shows the desirability of ivermectin registration for crusted scabies in Poland. StReSZCZenie Świerzb jest szeroko rozpowszechnioną, zakaźną chorobą pasożytniczą, która występuje we wszystkich grupach społeczno-ekonomicznych. Światowa Organizacja Zdrowia (WHO) umieściła świerzb na liście tzw. neglected tropical diseases (zaniedbanych chorób tropikalnych). Ostatnie badania wskazują, że aż u 45% pacjentów ze świerzbem stawiana jest błędna diagnoza. Świerzb hiperkeratotyczny jest rzadką, ciężką i bardzo zakaźną postacią świerzbu, która występuje głównie u pacjentów w stanie immunosupresji lub osób z zaburzeniami psychicznymi. Standardowo w leczeniu świerzbu hiperkeratotycznego stosuje się miejscowy lek o działaniu świerzbobójczym w skojarzeniu z iwermektyną stosowaną doustnie. Celem pracy jest przedstawienie przypadku 19-letniego mężczyzny z zespołem Downa i zaburzeniami ogólnoustrojowymi, u którego rozpoznano świerzb hiperkeratotyczny i wdrożono leczenie iwermektyną doustnie z dobrym skutkiem. Wskazujemy, że iwermektyna stanowi skuteczny i bezpieczny środek w leczeniu świerzbu hiperkeratotycznego. Przedstawiony przypadek świadczy o celowości rejestracji w Polsce iwermektyny podawanej ogólnoustrojowo we wskazaniu do leczenia świerzbu hiperkeratotycznego.
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