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Chiriac A, Diaconeasa A, Miulescu R, Chiriac AE, Wollina U. Scabies in infants and children - a narrative review. Eur J Pediatr 2024; 183:2527-2536. [PMID: 38536458 DOI: 10.1007/s00431-024-05535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/21/2024]
Abstract
Scabies is a human ectoparasitosis caused by Sarcoptes scabei var. hominis. World-wide around 300 million patients are affected. Infants and children have the highest incidence rates. Poverty and overcrowding are social factors contributing to a higher risk of transmission and treatment failure. The leading symptom of the infestation is itch. Complications are bacterial infections that are responsible for mortality. Diagnosis is clinical. Non-invasive imaging technologies like dermoscopy can be used. Polymerase chain reaction (PCR) is less sensitive and specific than microscopy of skin scrapings. Treatment of choice is topical permethrin 5%. Ivermectin is the only oral drug FDA-approved for scabies. It should be used in cases non-responsive to topical therapy and in case of high number of infested patients in addition to topical therapy. Pseudo-resistance to treatment is not uncommon. New drugs are on the horizon. What is Known: • Pruritus is the leading symptom causing sleep disturbances and scratching with the risk of secondary bacterial infections. • Treatment failure is related to inappropriate application of topical drugs and asymptomatic family members. What is New: • COVID-19 pandemic and migration are contributing to an increased incidence of scabies. • New compounds to treat scabies are on the horizon.
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Affiliation(s)
- Anca Chiriac
- Department of Dermatology, Nicolina Medical Center, Iasi, Romania
- Apollonia University, Iasi, Romania
- Romanian Academy, P. Poni Institute of Macromolecular Chemistry, Iasi, Romania
| | - Adriana Diaconeasa
- Dermatology Ambulatory Care Center, "Grigore Alexandrescu" Clinical Emergency Hospital for Children, Bucharest, Romania
| | | | - Anca E Chiriac
- Department of Dermatology, Nicolina Medical Center, Iasi, Romania
- Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstrasse 41, 01067, Dresden, Germany.
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Gaurav V, Tyagi M, Grover C, Das S. Ungual Scabies: A Case Report and Review of Literature. Skin Appendage Disord 2024; 10:60-68. [PMID: 38318430 PMCID: PMC10838528 DOI: 10.1159/000533881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/18/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Nail unit infestation by scabies mites (ungual scabies) is uncommon. It usually presents with distal subungual lesions, leading to recurrent and persistent disease by acting as a reservoir of infection. Periungual involvement in scabies with nail loss is rare and may lead to severe nail damage. Case Presentation We report a 14-year-old boy on chemotherapy for acute lymphocytic leukemia (ALL) who presented with extensive scaling and crusted plaques of scabies. Nail unit revealed periungual crusted plaques with paronychia and onychomadesis involving five digits. It was associated with partial to complete nail loss. Dermoscopy of periungual crusted plaques showed greyish-white scales with brown dots and globules. A sinuous burrow with a brown-triangular structure was visualized in the web space. KOH mount from skin scrapings showed the scabies mites. Treatment of scabies led to a marked improvement. Conclusion Though ungual scabies is generally a benign disease, proximal periungual involvement with damage to nail matrix is possible, leading to nail loss. We review manifestations of nail unit scabies reported in literature. Treatment options used and outcomes are also analyzed. The importance of nail-directed therapy in preventing relapses of scabies cannot be undermined.
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Affiliation(s)
- Vishal Gaurav
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Delhi, India
| | - Mehul Tyagi
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Delhi, India
| | - Chander Grover
- Department of Dermatology and Venereology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Talaga-Ćwiertnia K. Sarcoptes Infestation. What Is Already Known, and What Is New about Scabies at the Beginning of the Third Decade of the 21st Century? Pathogens 2021; 10:868. [PMID: 34358018 PMCID: PMC8308645 DOI: 10.3390/pathogens10070868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022] Open
Abstract
Currently, there are three known subtypes of scabies: ordinary, crusted, and bullous. The worldwide prevalence of scabies remains high in the 21st century. To decrease the social, economic, and psychological impact on the enormous population infected, a lot of important work has been completed over the last 20 years concerning the management of scabies. For example, a standardization of guidelines for the treatment of scabies has been completed and programs have been designed for the prevention and treatment in endemic populations, called mass drug administrations. Unfortunately, these only apply to the ordinary form of scabies. Moreover, resistance to the drugs currently used in treatment is growing, which imposes the need to search for new treatments. For this purpose, new acaricides are being developed to enhance the therapeutic options for the patients' benefit and effectively treat this disease. There is also the necessity for prevention before the development of scabies. An effective vaccine has the potential to protect people before this disease, especially in endemic areas. Unfortunately, there are no such vaccines against Sarcoptes yet.
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Affiliation(s)
- Katarzyna Talaga-Ćwiertnia
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Infection Control and Mycology, 31-008 Kraków, Poland
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A systematic review and an individual patient data meta-analysis of ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current contraindication? PLoS Negl Trop Dis 2021; 15:e0009144. [PMID: 33730099 PMCID: PMC7968658 DOI: 10.1371/journal.pntd.0009144] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/13/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Oral ivermectin is a safe broad spectrum anthelminthic used for treating several neglected tropical diseases (NTDs). Currently, ivermectin use is contraindicated in children weighing less than 15 kg, restricting access to this drug for the treatment of NTDs. Here we provide an updated systematic review of the literature and we conducted an individual-level patient data (IPD) meta-analysis describing the safety of ivermectin in children weighing less than 15 kg. METHODOLOGY/PRINCIPAL FINDINGS A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for IPD guidelines by searching MEDLINE via PubMed, Web of Science, Ovid Embase, LILACS, Cochrane Database of Systematic Reviews, TOXLINE for all clinical trials, case series, case reports, and database entries for reports on the use of ivermectin in children weighing less than 15 kg that were published between 1 January 1980 to 25 October 2019. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42017056515. A total of 3,730 publications were identified, 97 were selected for potential inclusion, but only 17 sources describing 15 studies met the minimum criteria which consisted of known weights of children less than 15 kg linked to possible adverse events, and provided comprehensive IPD. A total of 1,088 children weighing less than 15 kg were administered oral ivermectin for one of the following indications: scabies, mass drug administration for scabies control, crusted scabies, cutaneous larva migrans, myiasis, pthiriasis, strongyloidiasis, trichuriasis, and parasitic disease of unknown origin. Overall a total of 1.4% (15/1,088) of children experienced 18 adverse events all of which were mild and self-limiting. No serious adverse events were reported. CONCLUSIONS/SIGNIFICANCE Existing limited data suggest that oral ivermectin in children weighing less than 15 kilograms is safe. Data from well-designed clinical trials are needed to provide further assurance.
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Sechi A, Chessa MA, Patrizi A, Savoia F, Neri I. Periungual scabies in infants: a tough reservoir of mites presenting with lamellar desquamation. Arch Dis Child 2020; 105:703. [PMID: 30850380 DOI: 10.1136/archdischild-2019-316890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Andrea Sechi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marco Adriano Chessa
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesco Savoia
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Iria Neri
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Nemecek R, Stockbauer A, Lexa M, Poeppl W, Mooseder G. Anwendungsfehler bei lokaler Skabiestherapie: eine Beobachtungsstudie. J Dtsch Dermatol Ges 2020; 18:554-560. [PMID: 32519488 DOI: 10.1111/ddg.14122_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Romina Nemecek
- Abteilung für Dermatologie und Tropenmedizin, Sanitätszentrum Ost, Österreichisches Bundesheer, Wien, Österreich
| | - Anna Stockbauer
- Abteilung für Dermatologie und Tropenmedizin, Sanitätszentrum Ost, Österreichisches Bundesheer, Wien, Österreich
| | - Martina Lexa
- Heeresapotheke, Sanitätszentrum Ost, Österreichisches Bundesheer, Wien, Österreich
| | - Wolfgang Poeppl
- Abteilung für Dermatologie und Tropenmedizin, Sanitätszentrum Ost, Österreichisches Bundesheer, Wien, Österreich
| | - Gerhard Mooseder
- Abteilung für Dermatologie und Tropenmedizin, Sanitätszentrum Ost, Österreichisches Bundesheer, Wien, Österreich
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Nemecek R, Stockbauer A, Lexa M, Poeppl W, Mooseder G. Application errors associated with topical treatment of scabies: an observational study. J Dtsch Dermatol Ges 2020; 18:554-559. [PMID: 32469466 DOI: 10.1111/ddg.14122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND In recent years, there has been a significant increase in scabies infestations throughout German-speaking countries. Given the high frequency of treatment failures, the question arises as to whether topical permethrin treatment is always performed correctly. PATIENTS AND METHODS Our department uses a fluorescent test cream to teach patients on how to correctly apply topical permethrin. In the context of a prospective observational study of 21 patients, we systematically assessed and analyzed potential application errors. RESULTS None of the participants succeeded in adequately applying the cream to the entire skin as previously instructed. The median number of regions left untreated was six (minimum: 2; maximum: 18), which included a median body surface area of 6 % (minimum: 2 %; maximum: 30 %). With regard to predilection sites of scabies, the ankles were left untreated in 62 % of cases, followed by the interdigital spaces (toes) (33 %) and the sacral region (24 %). All patients considered the pretreatment training to be very useful. CONCLUSIONS The present findings clearly demonstrate potential shortcomings when it comes to the application of topical antiscabies treatment. This may provide a (potentially underestimated) explanation for the large number of reports on treatment failures in this regard, which falsely suggest potential treatment resistance.
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Affiliation(s)
- Romina Nemecek
- Department of Dermatology and Tropical Medicine, Military Medical Center East, Austrian Armed Forces, Vienna, Austria
| | - Anna Stockbauer
- Department of Dermatology and Tropical Medicine, Military Medical Center East, Austrian Armed Forces, Vienna, Austria
| | - Martina Lexa
- Military Pharmacy, Military Medical Center East, Austrian Armed Forces, Vienna, Austria
| | - Wolfgang Poeppl
- Department of Dermatology and Tropical Medicine, Military Medical Center East, Austrian Armed Forces, Vienna, Austria
| | - Gerhard Mooseder
- Department of Dermatology and Tropical Medicine, Military Medical Center East, Austrian Armed Forces, Vienna, Austria
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Bataille P, Welfringer-Morin A, Leclerc-Mercier S, Hadj-Rabia S, Bodemer C. An unsual case of palmoplantar keratoderma. Pediatr Dermatol 2020; 37:e17-e19. [PMID: 31997441 DOI: 10.1111/pde.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Pauline Bataille
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hopital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Université de Paris Descartes, Paris, France
| | - Anne Welfringer-Morin
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hopital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Université de Paris Descartes, Paris, France
| | - Stéphanie Leclerc-Mercier
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hopital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Université de Paris Descartes, Paris, France
| | - Smail Hadj-Rabia
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hopital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Université de Paris Descartes, Paris, France
| | - Christine Bodemer
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hopital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Université de Paris Descartes, Paris, France
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Chinazzo M, Desoubeaux G, Leducq S, Bessis D, Droitcourt C, Mahe E, Goujon E, Bursztejn AC, Phan A, Maruani A. Prevalence of Nail Scabies: A French Prospective Multicenter Study. J Pediatr 2018; 197:154-157. [PMID: 29576324 DOI: 10.1016/j.jpeds.2018.01.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To assess the prevalence of nail involvement in children <16 years old with a confirmed diagnosis of scabies. STUDY DESIGN Observational, prospective study in 7 French dermatology departments between June 2015 and January 2017. Children were included if they had scabies confirmed by dermoscopy and/or microscopy and if nails could be sampled. The first toenails and thumbnails as well as clinically affected nails were systematically sampled for microscopic examination. Individual data were recorded via a standardized questionnaire. RESULTS A total of 47 children with scabies were included (26 females [55.3%], mean age 3.6 ± 4.0 years). Pruritus was present in 42 children (89.3%); the relapse rate was 38.3% (n = 18). In 3 infants (6.4%), Sarcoptes mites were revealed by dermoscopy or microscopy of the first toenails (2 cases) and a thumbnail (1 case), but nails were normal in 2 children. Two of the 3 infants had already received treatment for scabies in the previous weeks. CONCLUSION Prevalence of nail involvement in children with confirmed scabies was 6.4%. Nails should not be overlooked during scabies treatment.
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Affiliation(s)
- Marie Chinazzo
- Pediatric Emergency Department, Centre Hospitalier Régional et Universitaire Tours, Tours, France
| | - Guillaume Desoubeaux
- University François Rabelais Tours, Faculty of Medicine, Tours, France; Department of Parasitology and Mycology, Centre Hospitalier Régional et Universitaire Tours, Tours, France
| | - Sophie Leducq
- University François Rabelais Tours, Faculty of Medicine, Tours, France; Department of Dermatology, Unit of Paediatric Dermatology, Centre Hospitalier Régional et Universitaire Tours, Tours, France
| | - Didier Bessis
- Department of Dermatology, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Catherine Droitcourt
- Department of Dermatology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Emmanuel Mahe
- Department of Dermatology, Centre Hospitalier Argenteuil, Argenteuil, France
| | - Elisa Goujon
- Department of Dermatology, Centre Hospitalier Chalon-sur-Saone, Chalon-sur-Saone, France
| | | | - Alice Phan
- Department of Dermatology, Centre Hospitalier Universitaire Lyon, Lyon, France
| | - Annabel Maruani
- University François Rabelais Tours, Faculty of Medicine, Tours, France; Department of Dermatology, Unit of Paediatric Dermatology, Centre Hospitalier Régional et Universitaire Tours, Tours, France.
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