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Review
. 2021 Mar 26:10:2020-12-3.
doi: 10.7573/dic.2020-12-3. eCollection 2021.

Paediatrics: how to manage scabies

Russell Thompson  1   2 , Sean Westbury  3 , Dana Slape  4   5   6
Affiliations
Review

Paediatrics: how to manage scabies

Russell Thompson et al. Drugs Context. .

Abstract

This narrative review addresses scabies, a highly contagious, pruritic infestation of the skin caused by the mite Sarcoptes 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.

Keywords: ivermectin; mites; permethrin; pruritus; scabies.

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Conflict of interest statement

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2021/03/dic.2020-12-3-COI.pdf

Figures

Figure 1
Figure 1
Warren L. Microscopic section of Sarcoptes scabiei mite showing eight legs and the bite apparatus (photo) (2020).
Figure 2
Figure 2
McCrossin I. Histological slide with haematoxylin and eosin staining showing a mite in the epidermis (photo) (2020).
Figure 3
Figure 3
Warren L. Severe classical scabies affecting the torso of an infant (photo) (2020).
Figure 4
Figure 4
Wong L. Scabies affecting the axilla of a child (photo) (2020).
Figure 5
Figure 5
Wong L. Scabies affecting the plantar surface of the foot (photo) (2020).
Figure 6
Figure 6
Wong L. Scabies affecting the volar surface of the wrist of a child (photo) (2020).
Figure 7
Figure 7
Slape D. Typical scabies lesion, identifying the head, body, and tail (Delta wing sign) (photo) (2020).
Figure 8
Figure 8
McCrossin I. Skin scrapings visualised with microscopy showing ova and scybala (photo) (2018).
Figure 9
Figure 9
Slape D. Secondarily infected scabies affecting a child’s leg (photo) (2020).
Figure 10
Figure 10
Summary instructions for managing scabies. MRSA: methicillin-resistant S. aureus; GAS: Group A Streptococcus pyogenes.
See this image and copyright information in PMC

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