Paediatrics: how to manage scabies

Abstract

This narrative review addresses scabies, a highly contagious, pruritic infestation of the skin caused by the mite S arcoptes scabiei var hominis . Scabies is a common disorder that has a prevalence worldwide estimated to be between 200 and 300 million cases per year. Infestation is of greatest concern in children, the elderly, immunocompromised people and resource-poor endemic populations at risk of chronic complications. A diagnosis of scabies involves a clinical suspicion, a detailed targeted history, clinical examination and contact tracing. Dermoscopy and microscopy, where available, is confirmatory. Due to its infectivity and transmissibility, the management for scabies requires a multimodal approach: topical antiscabetic agents are the first line for most cases of childhood classic scabies and their contacts, which must also be identified and treated to prevent treatment failure and reacquisition. Environmental strategies to control fomite-related reinfestation are also recommended. Oral ivermectin, where available, is reserved for use in high-risk cases in children or in mass drug administration programmes in endemic communities. The prevention of downstream complications of scabies includes surveillance, early identification and prompt treatment for secondary bacterial infections, often superficial but can be serious and invasive with associated chronic morbidity and mortality. Post-scabetic itch and psychosocial stigma are typical sequelae of the scabies mite infestation. The early identification of patients with scabies and treatment of their contacts reduces community transmission. Although time consuming and labour intensive for caregivers, the implementation of appropriate treatment strategies usually results in prompt cure for the child and their contacts. Here, we provide a summary of treatments and recommendations for the management of paediatric scabies.

Comparison of Permethrin-Based Treatment Strategies against Scabies in Infants and Young Children

“…In children, the prevalence of scabies is estimated to be around 5-10%, and infants and children younger than two years constitute a particularly-vulnerable population. [1][2][3] In this age group, infestations may be more frequentowing to the increased proximity to other infected individuals, the children´s thinner skin and/or immaturity of the immune system. 22 However, inherent limitations to the use of scabicides hamper management in infants and young children.…”

Serial dermoscopic monitoring of subungual scabies mites in an infant with crusted scabies

“…Crusted scabies rarely affects children and presents as generalized, psoriasiform and hyperkeratotic lesions with nail involvement. 1,2 Dermoscopy is simple, rapid and non-invasive for scabies diagnosis and therapeutic monitoring, and its pathognomonic jet-with-contrail or delta-wing jet sign represents pigmented mite head and trailing burrow. 1,2 However, serial dermoscopic monitoring of nail scabies has been unreported.…”

“…Infantile scabies becomes a diagnostic challenge due to polymorphic eruption and wide distribution, with missed diagnoses in almost half of suspected cases. 2,3 Additionally, scabietic nodules may be the primary and monomorphic manifestations in infants. 4 Therefore, personal/family anamnesis and full examination are mandatory for suspected cases, and visualization of mites, eggs or faeces using dermoscopy or microscopy confirms the diagnosis.…”

MRSA Femoral Osteomyelitis from Superinfected Scabies Lesions: A Pediatric Case Report

“…In high-income settings, the disease occurs sporadically, but outbreaks may occur [ 3 ]. Scabies infestation can occur at any age, but most cases occur in pediatric patients [ 4 , 5 ], with the highest prevalence in infants younger than 2 years old [ 6 ]. Classic scabies generally presents 4 to 6 weeks after infestation [ 7 ].…”

“…Crusted scabies, also known as Norwegian scabies, is a clinical variant of scabies that is highly contagious as it is associated with a heavy mite burden [ 11 ]. Crusted scabies is rare in children and usually affects immunocompromised hosts [ 5 ]. Skin usually appears “crusted” with widespread hyperkeratotic papules and fissured plaques [ 12 ].…”