A Review of Scabies: An Infestation More than Skin Deep

Abstract

Human scabies, a common infestation, has a worldwide distribution with a variable impact and presentation depending on the clinical situation. In developed, high-income settings, health institution and residential home outbreaks challenge health and social care services. In resource-poor settings, it is the downstream sequelae of staphylococcal and streptococcal bacteraemia, induced by scratching, which have a significant impact on the long-term health of communities. Over the past decade scabies has been recognised as a “neglected tropical disease” (NTD) by the World Health Organisation, has an accepted practical system of global diagnostic criteria and is being adopted into integrated programmes of mass drug administration for NTDs in field settings. This review seeks to summarise the recent advances in the understanding of scabies and highlight the advocacy and research headlines with their implication for diagnosis and management of outbreaks and individuals. In addition, it will indicate the priorities and questions that remain.

Classic and Non-classic (Surrepticius) Scabies: Diagnostic and Treatment Considerations

“…And, similar to the use of imaging devices, a dermatoscope evaluation for scabies is also a user-dependent technique. Indeed, even a dermatologist who has been trained in the routine use of a dermatoscope for inspecting pigmented lesions may have less experience identifying the scabies-associated 'jetliner with its trail' sign (which has also been referred to as the 'delta glider', 'delta-wing jet', 'jet with contrail' and 'spermatozoid' sign) of the mite head and training burrow [8,14,15].…”

“…Therefore, treatment of the home environment (including fomites such as clothing, bed sheets and covers) is usually not necessary, except in institutional settings, for patients with classic scabies in whom only five to fifteen mites are estimated to be present on their body. However, for the highly infectious patients with crusted scabies -in whom hundreds to thousands of mites are present within the hyperkeratotic scale that is inadvertently being shed -environmental measures to prevent fomite transmission are recommended [4,8,14,16].…”

Climatic changes and their role in emergence and re-emergence of diseases

“…One of the best examples is the human scabies caused by Sarcoptes scabiei mites. Although the parasitic disease has a global distribution, the prevalence in Europe was very low (Chandler and Fuller 2019). Outbreaks of scabies in Europe could be observed in the last decade such as in Kindergarten in Germany in 2013 (Ariza et al 2013) and in German Health Care Centre (Leistner et al 2017) and in elderly home in the UK (Cassell et al 2018).…”

Lemongrass (Cymbopogon citratus) oil: A promising miticidal and ovicidal agent against Sarcoptes scabiei

“…Currently, topical permethrin and oral ivermectin are the two most commonly used treatments for scabies [32]. However, both drugs are only available for scabies in a limited number of countries over the world, and both drugs are expensive [2,33].…”