Scabies and nocturnal pruritus: preliminary observations in a group of African migrants

Abstract

Introduction: Pruritus of scabies is due to a type IV T cell-mediated reaction to the mite’s saliva, eggs, excrements and other products released by the mite during its life cycle. Movements of the mite also induce pruritus. According to the literature, scabies pruritus has higher frequency and intensity at night.
 Methodology: In this short communication we present the results of a survey on nocturnal pruritus in a group of African migrants with scabies. A questionnaire was given to 36 patients: “Is your pruritus more severe at night?” and “Do you wake up from the sleep because of pruritus?”.
 Results: The answer to the first question was “yes” in 13/18 patients (72.2%) visited from October 2018 to February 2019, and in 6/18 patients (33.3%) visited from May to September 2019. The answer to the second question was “yes” in 11/18 patients (61.1%) of the first group and in 5/18 patients (27.7%) of the second group.
 Conclusions: It is possible that nocturnal pruritus in scabies is due to the temperature of the skin surface: when it is high, because of the use of pajamas, heavy sheets and blankets (from October to February), pruritus increases; when the skin’s temperature is low, as in the summertime, when people usually sleeps without blankets, with light sheets and pajamas or not having a stitch on, pruritus is less frequent and severe. These conclusions must be confirmed by studies based on larger groups of patients.

Two‐year, single‐centre, real‐life experience with permethrin 5% and benzyl benzoate 25% in 228 children with scabies: A retrospective report

“…7 However, some authors have proposed that the increased incidence of scabies and its poor response to treatment may not rarely be pseudoresistance, due to inadequate counselling by physicians, (insufficient quantity of product, short treatment time), incorrect treatment, and poor compliance. 9,10 During the last 2 years the number of children with scabies observed has increased (Table 1). The socioeconomic characteristics have not changed, and most of our patients were from nonindigenous, low-income families with multiple components, as has been observed in other series.…”

“…A decreased efficacy of P5% in Sarcoptes scabiei hominis has been recently demonstrated both in vitro 6 and in vivo 7 . However, some authors have proposed that the increased incidence of scabies and its poor response to treatment may not rarely be pseudoresistance, due to inadequate counselling by physicians, (insufficient quantity of product, short treatment time), incorrect treatment, and poor compliance 9,10 . During the last 2 years the number of children with scabies observed has increased (Table 1).…”

“…Some authors found that Sarcoptes scabiei has developed an intrinsic resistance to permethrin, prompting a search of alternative treatments 6,7 while other publications highlight a change in subjects at risk and the presence of pseudo-resistance due to population factors. [8][9][10] Having observed cases of failure with permethrin, in 2021 we reintroduced benzyl benzoate in treating scabies in children >2 months of age. Benzyl benzoate is an alternative topical treatment approved in Europe 11 ; despite its efficacy its use in children is limited, real-life studies are scarce and treatment schemes vary.…”

“…The causes of this phenomenon are still debated. Some authors found that Sarcoptes scabiei has developed an intrinsic resistance to permethrin, prompting a search of alternative treatments 6,7 while other publications highlight a change in subjects at risk and the presence of pseudo‐resistance due to population factors 8–10 . Having observed cases of failure with permethrin, in 2021 we reintroduced benzyl benzoate in treating scabies in children >2 months of age.…”

Impact of Scabies on Sleep Quality

“…23 In scabies patients, pruritus is classified as secondary pruritus with pruritoceptive pathophysiology, meaning that various inflammatory mediators activate the cutaneous nerve endings. Itching is caused by immune responses of type IV, 24 which are delayed in nature. 25 Mites trigger an inflammatory reaction by releasing substances from their eggs, feces, excrement, saliva, and feet while digging tunnels.…”