Diagnosis and treatment response monitoring of scabies with reflectance confocal microscopy: A diagnostic pearl

Dermoscopic and reflectance confocal microscopic features of children scabies

OBJECTIVE

To summarize the image features of dermatoscopy and reflectance confocal microscopy (RCM) in children with scabies, and to explore the clinical significance in the diagnosis of children scabies.

METHODS

A retrospective analysis was conducted on 102 children scabies diagnosed clinically in the dermatology outpatient department of Tianjin Children's Hospital from April 2018 to June 2022. All children were examined by dermatoscopy and RCM, and images were collected.

RESULTS

102 patients, 92 patients (90.2%) showed characteristic dermoscopic manifestations: white tunnels and small brown or dark brown triangular structures at their ends. 91 patients (89.2%) showed characteristic reflectance confocal microscopic manifestations: tunnels, scabies mites, feces, and eggs in the epidermal layer. All patients showed different degrees of non-specific manifestations of dermoscopy and RCM.

CONCLUSION

Children scabies have typical dermatoscopic and reflectance confocal microscopic characteristics, and dermatoscopy and RCM are effective non-invasive diagnostic methods with high clinical application value in the diagnosis and differential diagnosis of children scabies.

Common pediatric infestations: update on diagnosis and treatment of scabies, head lice, and bed bugs

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.

[Noninvasive diagnostic imaging in pediatric skin lesions]

Optical coherence tomography (OCT) and reflectance confocal laser microscopy (RCM) allow noninvasive imaging diagnostics of the skin. Since the indication for a biopsy in children is generally made cautiously, OCT and KLM can be helpful in the clarification of pediatric skin lesions. In addition, biopsies only represent a snapshot of a small area of the skin, while noninvasive methods allow several locations to be examined over time, so that dynamic changes and the course of therapy can also be determined. In pediatric dermatology, these diagnostic methods are particularly suitable for the clarification of atypical pigment lesions, for infectious dermatoses such as scabies or tinea, and for the diagnosis of inflammatory and degenerative dermatoses.