Clinical Phenotype of Scabies by Age

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Scabies is a frequent cause of consultation and has recently been classified as a neglected disease. The clinical presentation seems to be linked with age, although no specific study has aimed to delineate the clinical spectrum of scabies in infants and children.WHAT THIS STUDY ADDS: Scabies in infants and children has distinct clinical features. This prospective observational study found that infants were more likely to have relapse, nodules, and to present involvement with extremities, face, and scalp, arguing for specific cares in this age group. abstract OBJECTIVE: Scabies has a clinical presentation that seems to vary according to age. We conducted a prospective study with the goal of delineating the clinical presentation of the disease into 3 groups of age: infants, ,2 years; children, 2 to 15 years; and adults, .15 years. METHODS:This trial was a prospective, multicenter observational study in consecutive patients with a confirmed diagnosis of scabies who were seen in 13 French Departments of Dermatology and Pediatric Dermatology between April 2010 and April 2011. A standardized questionnaire was completed for each patient. To identify factors associated with patient age, comparisons between the 3 age groups were conducted by using univariate and multivariate multinomial logistic regression analyses.RESULTS: A total of 323 individuals were included; the gender ratio (female:male) was 1.2:1. In univariate analysis, infants were more likely to have facial involvement. In multivariate logistic regression, relapse was more frequent in children (odds ratio [OR] .51]) involvement were also found to be independently associated with the age group ,2 years. CONCLUSIONS:There is a specific clinical presentation of scabies in infants and children. Taking into account these specificities may be helpful for the early diagnosis and the identification of cases to prevent the propagation of the disease. Pediatrics 2014;133:e910-e916 AUTHORS:

Escabiose: Revisão e Foco na Realidade Portuguesa

“…Nem sempre são evidentes, podendo estar mascarados pela escoriação, eczematização ou infeção secundária. 1,2,5,12,16 Os locais de eleição das lesões de escabiose são as pregas interdigitais das mãos e as faces laterais dos dedos das mãos, faces flexoras dos punhos ( Fig. 1), axilas, cotovelos, umbigo, cintura pélvica, tornozelos, pés e nádegas.…”

“…2,22 Num estudo prospetivo, que incluiu 323 crianças, verificou-se que o grupo de crianças com idade inferior a 2 anos apresentava como características distintivas um atingimento preferencial da cabeça, plantas e dorso dos pés, bem como a existência de familiares com prurido. 12 As recidivas foram mais frequentes em idades inferiores a 15 anos.…”

“…Estudos em idade pediátri-ca mostraram que o erro diagnóstico ocorreu em 41% dos casos, 10 e o intervalo de tempo até ao diagnóstico variou de 35 a 62 dias. 11,12 MATERIAL E MÉTODOS Os autores efetuaram uma revisão narrativa do tema, em livros e bases de dados científicas (PubMed/Medline, Cochrane, UpToDate, IndexRMP) com seleção de informação relevante sobre escabiose, utilizando os termos (ou combinação de termos): "scabies", "transmission", "diagnosis", "treatment", "pediatric", "Portugal". Foram incluídos artigos de revisão, estudos observacionais, meta-análises, e pontualmente casos clínicos, em inglês e português, escritos nos últimos 20 anos (com exceção para artigos mais antigos que incluímos pela sua relevância).…”

“…2,13 No adulto, encontram-se nas axilas, genitais e nádegas; e nas crianças podem ser encontrados em qualquer área do tegumento (mas nas menores de 2 anos observam-se sobretudo no dorso e axilas). 12 Podem estar presentes na fase de infestação ativa, ou persistir meses mesmo após um tratamento bem sucedido. 5,13,16 A sarna crostosa (ou norueguesa) é uma variante grave de escabiose em que ocorre uma hiperproliferação de ácaros não suprimida pelo sistema imune do hospedeiro.…”

Identification and treatment of scabies in infants

“…Recent research found that involvement of the scalp and plantar surfaces of the feet were seen exclusively in patients less than two years old, and facial involvement was similarly unique to those under 15 (Boralevi et al 2014). Infants and young children may therefore present with both atypical distribution of lesions and non-specific symptoms such as poor feeding, disturbed sleep pattern and apparent distress (Johnston and Sladden 2005).…”