Abstract
Objective: This study examined patients referred to the pediatric and pediatric allergy departments of Şırnak State Hospital with preliminary diagnoses of scabies and atopic dermatitis, who were diagnosed with scabies and underwent treatment, as well as the applied treatment and treatment responses. The aim of this study was to contribute to the literature.
Materials and Methods: Data from 77 pediatric patients aged 0–18 years who were referred to the Pediatric Allergy and Immunology and Pediatric Health and Diseases outpatient clinics of Şırnak State Hospital with a preliminary diagnosis of scabies or atopic dermatitis between May 2025 and November 2025 were retrospectively reviewed. Demographic characteristics, household size, bed sharing, nocturnal itching, family history of similar complaints, treatment adherence, treatment use by all individuals in the household, hygiene practices, and clinical treatment response were evaluated.
Results: The study included a total of 77 child patients, 29 of whom were girls (37.7%) and 48 were boys (62.3%). The youngest patient was 1 year old and the oldest was 17 years old. A total of 35.1 of the cases were treated with a diagnosis of atopic dermatitis at the initial presentation. Itching that woke the patient from sleep at night was observed in 77.9%, and a family history of similar complaints was observed in 67.5%. Bed sharing was observed in 28.6%, and dormitory living in 9.1%. The rate of patients who achieved clinical benefit from Scabies treatment was 59.7%. While no treatment success was achieved in patients who shared a bed, clinical improvement was observed in 83.6% of those who did not share a bed (p<0.001). Failure to use the treatment together among all individuals in the household and failure to comply with hygiene measures were significantly associated with treatment failure (p<0.001). In the logistic regression analysis, household size and a diagnosis of AD at the initial presentation were significantly associated with treatment failure (B = 3.763, p < 0.001 and B = 8.477, p = 0.022, respectively).
Conclusion: The most important determinants of treatment failure in children with scabies are crowded household structure, bed sharing, failure to treat all individuals in the household simultaneously, and inadequate hygiene practices. Cases confused with atopic dermatitis lead to delays in diagnosis. Early diagnosis, correct treatment, and simultaneous treatment of all contacts are critically important in controlling the disease.
References
- Hengge UR, Currie BJ, Jäger G, Lupi O, Schwartz RA. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis. 2006;6(12):769-79. https://doi.org/10.1016/S1473-3099(06)70654-5
- Anderson KL, Strowd LC. Epidemiology, Diagnosis, and Treatment of Scabies in a Dermatology Office. J Am Board Fam Med. 2017;30(1):78-84. https://doi.org/10.3122/jabfm.2017.01.160190
- Ständer S, Ständer S. Itch in Scabies-What Do We Know? Front Med (Lausanne). 2021;8:628392. https://doi.org/10.3389/fmed.2021.628392
- Burgess I. Sarcoptes scabiei and scabies. Adv Parasitol. 1994;33:235-92. https://doi.org/10.1016/S0065-308X(08)60414-5
- Cassell JA, Middleton J, Nalabanda A, Lanza S, Head MG, Bostock J, et al. Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes. Lancet Infect Dis. 2018;18(8):894-902. https://doi.org/10.1016/S1473-3099(18)30347-5
- Aždajić MD, Bešlić I, Gašić A, Ferara N, Pedić L, Lugović-Mihić L. Increased Scabies Incidence at the Beginning of the 21st Century: What Do Reports from Europe and the World Show? Life (Basel). 2022;12(10). https://doi.org/10.3390/life12101598
- Orion E, Matz H, Wolf R. Ectoparasitic sexually transmitted diseases: scabies and pediculosis. Clin Dermatol. 2004;22(6):513-9. https://doi.org/10.1016/j.clindermatol.2004.07.004
- Sunderkötter C, Feldmeier H, Fölster-Holst R, Geisel B, Klinke-Rehbein S, Nast A, et al. S1 guidelines on the diagnosis and treatment of scabies short version. J Dtsch Dermatol Ges. 2016;14(11):1155-67. https://doi.org/10.1111/ddg.13130
- Salavastru CM, Chosidow O, Boffa MJ, Janier M, Tiplica GS. European guideline for the management of scabies. J Eur Acad Dermatol Venereol. 2017;31(8):1248-53. https://doi.org/10.1111/jdv.14351
- Mazzatenta C, Piccolo V, Argenziano G, Bassi A. Is Scabies becoming less sensitive to permethrin therapy? J Eur Acad Dermatol Venereol. 2021;35(9):e607-e9. https://doi.org/10.1111/jdv.17339
- Bassi A, Piccolo V, Argenziano G, Mazzatenta C. Topical ivermectin: an off-label alternative to treat neonatal Scabies in the era of permethrin resistance. J Eur Acad Dermatol Venereol. 2022;36(7):e557-e9. https://doi.org/10.1111/jdv.18026
- Veraldi S, Schianchi R, Silvio M, Aromolo IF. Pseudoresistance to permethrin in scabies. J Infect Dev Ctries. 2023;17(5):713-5. https://doi.org/10.3855/jidc.17750
- Özden MG, Ertürk K, Kartal SP, Yayli S, Göktay F, Doğramacı CA, et al. An extraordinary outbreak of scabies in Turkey. J Eur Acad Dermatol Venereol. 2020;34(12):e818-e20. https://doi.org/10.1111/jdv.16699
- Ariza L, Walter B, Worth C, Brockmann S, Weber ML, Feldmeier H. Investigation of a scabies outbreak in a kindergarten in Constance, Germany. Eur J Clin Microbiol Infect Dis. 2013;32(3):373-80. https://doi.org/10.1007/s10096-012-1752-1
- Lifschitz C. The impact of atopic dermatitis on quality of life. Ann Nutr Metab. 2015;66 Suppl 1:34-40. https://doi.org/10.1159/000370226
- Mounsey KE, Murray HC, King M, Oprescu F. Retrospective analysis of institutional scabies outbreaks from 1984 to 2013: lessons learned and moving forward. Epidemiol Infect. 2016;144(11):2462-71. https://doi.org/10.1017/S0950268816000443
- Schmitt J, von Kobyletzki L, Svensson A, Apfelbacher C. Efficacy and tolerability of proactive treatment with topical corticosteroids and calcineurin inhibitors for atopic eczema: systematic review and meta-analysis of randomized controlled trials. Br J Dermatol. 2011;164(2):415-28. https://doi.org/10.1111/j.1365-2133.2010.10030.x
- Thaçi D, Reitamo S, Gonzalez Ensenat MA, Moss C, Boccaletti V, Cainelli T, et al. Proactive disease management with 0.03% tacrolimus ointment for children with atopic dermatitis: results of a randomized, multicentre, comparative study. Br J Dermatol. 2008;159(6):1348-56. https://doi.org/10.1111/j.1365-2133.2008.08813.x
- Wollenberg A, Frank R, Kroth J, Ruzicka T. Proactive therapy of atopic eczema--an evidence-based concept with a behavioral background. J Dtsch Dermatol Ges. 2009;7(2):117-21. https://doi.org/10.1111/j.1610-0387.2008.06772.x
- Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338-51. https://doi.org/10.1016/j.jaad.2013.10.010
- Chandler DJ, Fuller LC. A Review of Scabies: An Infestation More than Skin Deep. Dermatology. 2019;235(2):79-90. https://doi.org/10.1159/000495290
- Bernigaud C, Fischer K, Chosidow O. The Management of Scabies in the 21st Century: Past, Advances and Potentials. Acta Derm Venereol. 2020;100(9):adv00112. https://doi.org/10.2340/00015555-3468
- Karim SA, Anwar KS, Khan MA, Mollah MA, Nahar N, Rahman HE, et al. Socio-demographic characteristics of children infested with scabies in densely populated communities of residential madrashas (Islamic education institutes) in Dhaka, Bangladesh. Public Health. 2007;121(12):923-34. https://doi.org/10.1016/j.puhe.2006.10.019
- Ejigu K, Haji Y, Toma A, Tadesse BT. Factors associated with scabies outbreaks in primary schools in Ethiopia: a case-control study. Res Rep Trop Med. 2019;10:119-27. https://doi.org/10.2147/RRTM.S214724
- Leistner R, Buchwald D, Beyer M, Philipp S. Scabies outbreak among healthcare workers in a German acute care hospital. J Infect Prev. 2017;18(4):189-92. https://doi.org/10.1177/1757177417690920
- Oba MC, Ozkoca D, Basara Sahin R, Kazan DS, Guldiken G, Kara Esen B. Factors Affecting Topical Treatment Success in Pediatric Scabies Cases: A Cross-Sectional Study. Dermatol Pract Concept. 2023;13(4). https://doi.org/10.5826/dpc.1304a307
- Mbuagbaw L, Sadeghirad B, Morgan RL, Mertz D, Motaghi S, Ghadimi M, et al. Failure of scabies treatment: a systematic review and meta-analysis. Br J Dermatol. 2024;190(2):163-73. https://doi.org/10.1093/bjd/ljad308
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