Scabies

Abstract

Scabies is a contagious skin infestation caused by a mite. It causes significant global morbidity, with an estimated 300 million cases annually. Although it can affect individuals at any socioeconomic level, individuals who live in poverty or in overcrowded conditions are at much higher risk for scabies. Lack of local expertise can result in failure to recognize scabies, leading to delayed diagnosis and inadequate treatment of cases and contacts. Scabies disproportionately affects many Indigenous (First Nations, Inuit, Métis) communities where risk factors are present. Scabies risk is also higher in young children, the elderly and immunocompromised individuals. Institutional outbreaks of scabies have also been reported. Apart from a very itchy rash, scabies can lead to secondary bacterial infections and related complications, as well as to stigmatization, depression, insomnia and significant financial costs. Topical antiscabies lotions are still the mainstay of treatment, but oral ivermectin has also proven effective under certain circumstances. Asymptomatic and symptomatic household members should all be treated at the same time. In Canada and globally, the presence of scabies is usually a symptom of poor living conditions and a sign that basic necessities need improvement. Clinicians who work with Indigenous communities can improve their ability to diagnose and treat scabies, and should advocate for better living conditions where scabies is prevalent.

Scabies with Secondary Infection Resembling Kerion-Type Tinea Capitis

“… 1 , 4 Classic manifestations in scabies consist of burrow, papule, and generalized pruritus. 8 Each individual can have different clinical manifestations. On physical examination, excoriation and eczematous dermatitis can be found between the fingers, sides of the fingers, volar wrist and sides of the palms, elbows, axillae, genital area.…”

Ivermectin and permethrin for treating scabies

“…In recent years, topical permethrin and oral ivermectin have become the most relevant treatment options for scabies ( Banerji 2015 ; RKI 2016 ).…”

“…Application is sometimes repeated once, about one to two weeks later. Children aged two months or older can also be treated ( Currie 2010 ; Banerji 2015 ; CDC 2015 ; Sunderkötter 2016 ; CDC 2017b ; Salavastru 2017 ).…”

“…It has not been tested in pregnant or lactating woman and children weighing less than 15 kg. Furthermore, opinions diverge on whether the tablet should be taken with food or on an empty stomach ( Currie 2010 ; Banerji 2015 ; CDC 2015 ; Sunderkötter 2016 ; CDC 2017b ; Salavastru 2017 ).…”

Do we know how scabies outbreaks in residential and nursing care homes for the elderly should be managed? A systematic review of interventions using a novel approach to assess evidence quality

“…The elderly, young and immunocompromised are particularly vulnerable to scabies [10, 11], and RNC are especially susceptible to institutional outbreaks [12]. The typical distribution of clinical signs may differ in the elderly [8, 13, 14]; residents may be asymptomatic or have subtle signs, adding to difficulty in diagnosis in this population and contributing to delayed diagnosis.…”