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Uzun S, Durdu M, Yürekli A, Mülayim MK, Akyol M, Velipaşaoğlu S, Harman M, Taylan-Özkan A, Şavk E, Demir-Dora D, Dönmez L, Gazi U, Aktaş H, Aktürk AŞ, Demir G, Göktay F, Gürel MS, Gürok NG, Karadağ AS, Küçük ÖS, Turan Ç, Ozden MG, Ural ZK, Zorbozan O, Mumcuoğlu KY. Clinical practice guidelines for the diagnosis and treatment of scabies. Int J Dermatol 2024. [PMID: 38922701 DOI: 10.1111/ijd.17327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global impact is considerable, affecting more than 200 million individuals annually and posing significant challenges to healthcare systems worldwide. Transmission occurs primarily through direct skin-to-skin contact, contributing to its widespread prevalence and emergence as a substantial public health concern affecting large populations. This review presents consensus-based clinical practice guidelines for diagnosing and managing scabies, developed through the fuzzy Delphi method by dermatology, parasitology, pediatrics, pharmacology, and public health experts. The presence of burrows containing adult female mites, their eggs, and excreta is the diagnostic hallmark of scabies. Definitive diagnosis typically involves direct microscopic examination of skin scrapings obtained from these burrows, although dermoscopy has become a diagnostic tool in clinical practice. Treatment modalities encompass topical agents, such as permethrin, balsam of Peru, precipitated sulfur, and benzyl benzoate. In cases where topical therapy proves inadequate or in instances of crusted scabies, oral ivermectin is recommended as a systemic treatment option. This comprehensive approach addresses the diagnostic and therapeutic challenges associated with scabies, optimizing patient care, and management outcomes.
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Affiliation(s)
- Soner Uzun
- Department of Dermatology and Venereology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Murat Durdu
- Department of Dermatology, Adana Dr. Turgut Noyan Application and Research Center, Başkent University Faculty of Medicine, Adana, Turkey
| | - Aslan Yürekli
- Training and Research Hospital Dermatology Department, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Mehmet K Mülayim
- Faculty of Medicine, Department of Dermatology and Venereology, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Melih Akyol
- Department of Dermatology and Venereology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Sevtap Velipaşaoğlu
- Department of Social Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Mehmet Harman
- Department of Dermatology and Venereology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Ayşegül Taylan-Özkan
- Department of Medical Microbiology, Faculty of Medicine, TOBB University of Economics and Technology, Ankara, Turkey
| | - Ekin Şavk
- Department of Dermatology and Venereology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Devrim Demir-Dora
- Department of Medical Pharmacology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Levent Dönmez
- Department of Public Health, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Umut Gazi
- Department of Medical Microbiology and Clinical Microbiology, Near East University, Nicosia, Cyprus
| | - Habibullah Aktaş
- Department of Dermatology and Venereology, Karabük University Faculty of Medicine, Karabük, Turkey
| | - Aysun Ş Aktürk
- Department of Dermatology and Venereology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Gülay Demir
- Vocational School of Health Services, Sivas Cumhuriyet University, Sivas, Turkey
| | - Fatih Göktay
- Private Dermatology and Venereology Clinic, İstanbul, Turkey
| | - Mehmet S Gürel
- Department of Dermatology and Venereology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Neşe G Gürok
- University of Health Sciences Fethi Sekin City Hospital, Dermatology and Venereology Clinic, Elazığ, Turkey
| | - Ayşe S Karadağ
- Private Dermatology and Venereology Clinic, İstanbul, Turkey
| | - Özlem S Küçük
- Department of Dermatology and Venereology, Bezmialem Vakıf University Faculty of Medicine, İstanbul, Turkey
| | - Çağrı Turan
- Department of Dermatology and Venereology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Müge G Ozden
- Department of Dermatology, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey
| | - Zeynep K Ural
- Department of Dermatology and Venereology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Orçun Zorbozan
- Department of Medical Parasitology, Bakırcay University Faculty of Medicine, İzmir, Turkey
| | - Kosta Y Mumcuoğlu
- Parasitology Unit, Department of Microbiology and Molecular Genetics, the Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Buettcher M, Stebler AK, Theiler M, Kobylinski K, Pfister M. National survey in Switzerland calls for improved diagnosis and treatment in children with scabies. Swiss Med Wkly 2023; 153:40129. [PMID: 38579328 DOI: 10.57187/smw.2023.40129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
AIM OF THE STUDY The global prevalence of scabies is estimated to be up to 200 million cases annually, with young children particularly affected. In Europe, most cases are thought to originate in migrant populations. Scabies management is challenging in children. To identify knowledge gaps and research needs, we aimed to descriptively evaluate the management of children with scabies by different Swiss healthcare providers. METHODS An invitation for an anonymous online survey (36 questions) was sent to members of Swiss societies of dermatologists, general practitioners, paediatricians, paediatric dermatologists, paediatric infectious diseases specialists, and tropical medicine specialists, inviting clinicians to participate from 25th May to 8th August 2020. One reminder invitation was sent. Hospital pharmacies and the distributor of permethrin were contacted to report consumption trends of scabicides in 2018 and 2019. RESULTS The survey was completed by 248 clinicians: 146 (59%) paediatricians, 47 (19%) dermatologists, 28 (11%) general practitioners, 6 (2%) paediatric dermatologists, 13 (5%) paediatric infectious diseases specialists, and 8 (3%) tropical medicine specialists. Most consulted up to 10 scabies cases within a 16-month period, with similar numbers in migrant and Swiss children. Dermoscopy was used by 24% of non-dermatologists. Non-dermatologists did not consider co-treatment of close contacts in up to 59% of cases. While permethrin was the first-line treatment, treatment failures were frequently reported in children aged <5 years. Up to 67% of paediatric dermatologists regularly used oral ivermectin off-label in children weighing <15 kg. None of the paediatric dermatologists, 15% of the dermatologists, and 9% of the non-dermatologists used only one treatment cycle.Scabicide consumption increased. Treatment studies on ivermectin use in children weighing <15 kg had the highest research priority. CONCLUSION In Switzerland, scabies is a frequent dermatosis in migrant and Swiss children. While accessible, optimal diagnostics are underutilised, and treatment is suboptimal. Permethrin resistance appears to be an increasing problem. Dermatologists regularly use ivermectin off-label in children weighing <15 kg. Treatment studies on ivermectin use in children weighing <15 kg, user-friendly diagnostic tools, new treatment protocols, and child-friendly dosage forms are needed to improve the diagnosis and treatment of children with scabies.
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Affiliation(s)
- Michael Buettcher
- Paediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital Basel, Basel, Switzerland
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Lucerne Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Science and Medicine, University Lucerne, Lucerne, Switzerland
| | - Anita K Stebler
- Master of Medicine Student, Faculty of Medicine, University Basel, Basel, Switzerland
| | - Martin Theiler
- Paediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - Kevin Kobylinski
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Marc Pfister
- Paediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital Basel, Basel, Switzerland
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Bassi A, Mazzatenta C, Piccolo V. Diagnosis and management of pediatric scabies: Results from a survey on 317 Italian dermatologists. Travel Med Infect Dis 2022; 50:102461. [PMID: 36116769 DOI: 10.1016/j.tmaid.2022.102461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/29/2022] [Accepted: 09/12/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Andrea Bassi
- Division of Dermatology, Azienda USL Toscana Nord Ovest, Lucca, Italy.
| | - Carlo Mazzatenta
- Division of Dermatology, Azienda USL Toscana Nord Ovest, Lucca, Italy
| | - Vincenzo Piccolo
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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Morgado-Carrasco D, Piquero-Casals J, Podlipnik S. Tratamiento de la escabiosis. Aten Primaria 2022; 54:102231. [PMID: 35051892 PMCID: PMC8783089 DOI: 10.1016/j.aprim.2021.102231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/02/2022] Open
Abstract
La escabiosis afecta a más de 200 millones de personas en el mundo, y ocasiona un importante impacto socioeconómico. El mecanismo de contagio es por contacto directo prolongado. El contagio por fómites es infrecuente, aunque puede ser importante en la sarna noruega. La terapia con permetrina tópica al 5% es recomendada como tratamiento de primera línea. Puede indicarse durante el embarazo y la lactancia, y parece ser segura en niños < 2 meses. Sin embargo, últimamente se ha reportado una disminución de la efectividad de este fármaco. Otra alternativa en primera línea terapéutica es la ivermectina oral. Se puede administrar durante la lactancia, y estudios recientes sugieren que es segura en niños y lactantes pequeños. Diversas revisiones sistemáticas y metaanálisis han concluido que la ivermectina oral es tan efectiva y segura como la permetrina tópica. La administración terapéutica «en masa» de ivermectina oral es una excelente opción para el manejo de escabiosis en comunidades con alta prevalencia o de brotes en instituciones.
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Ogbuefi N, Kenner-Bell B. Common pediatric infestations: update on diagnosis and treatment of scabies, head lice, and bed bugs. Curr Opin Pediatr 2021; 33:410-415. [PMID: 34074914 DOI: 10.1097/mop.0000000000001031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW This review will update pediatric providers on the recent data regarding the epidemiology, diagnosis, and treatment of common skin infestations affecting children and adolescents. RECENT FINDINGS Standard superficial skin biopsy for scabies and the vacuum method for head lice can increase diagnostic accuracy and efficiency. There is growing resistance to some of the traditional treatments for scabies and head lice, and progress has been made in finding newer and potentially more effective treatments, such as oral moxidectin for scabies and abametapir for head lice. Recent studies have established the safety of traditional treatments, such as permethrin and oral ivermectin in infants and small children. SUMMARY Permethrin and ivermectin are both considered safe and effective for children and adolescents with scabies. Permethrin is generally considered safe in infants less than two months of age. Proper application of permethrin is critical, and providers should emphasize proper application technique. Treatment of head lice should only be initiated with active infestations. Resistance to permethrin continues to increase and other options are now available, including an over-the-counter topical ivermectin formulation. Identification and eradication of bed bug infestations are crucial in preventing bedbug bites.
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Affiliation(s)
| | - Brandi Kenner-Bell
- Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago
- Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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