Retrospective Evaluation of Misdiagnosed Scabies Cases: Clinical and Epidemiological Features and Resemblance to Other Dermatological Conditions

Yıl 2023, Cilt: 37 Sayı: 3, 281 - 290, 25.01.2024

Fatmagül Gülbaşaran Özlem Özbağcivan Samet Öner Onur Çapkan

https://doi.org/10.18614/deutip.1394726

Öz

Background and Aim: Diagnosing scabies, a skin condition caused by mites, can be challenging due to its resemblance to other skin problems. Avoiding misdiagnoses could result in a significant reduction in treatment delays and complications. Our objective was to investigate scabies cases that initially posed diagnostic challenges.
Methods: This retrospective study focused on scabies patients who were initially misdiagnosed despite routine clinical examinations and underwent histopathological examinations with different preliminary dermatological diagnoses. Inclusion criteria were in accordance with the 2020 International Alliance for the Control of Scabies Diagnosis Criteria. The study retrospectively compiled clinical, histopathological, and demographic characteristics, providing data on the challenges and delays in diagnosing scabies cases that mimic other dermatological conditions.
Results: In a cohort of 27 scabies cases with diagnostic challenges, the majority were females (63%) with a mean age of 64.8±15.9 years. Pre-admission, 66.7% of the patients used systemic antihistamines, 52.4% used immunosuppressants, and 42.9% used topical scabies treatment. Secondary xerosis cutis and contact dermatitis were noted in 11.1% and 7.4% of cases. The most frequently considered differential diagnoses by dermatologists included prurigo subacuta (29.6%), dermatitis herpetiformis (18.5 %), lymphomatoid papulosis (14.8%), and vesicular/bullous pemphigoid (11.1 %).
Conclusion: Previous treatments; prolonged infestations leading to severe secondary dermatological problems including prurigo subacuta, contact dermatitis, and xerotic eczema; atypical distribution of lesions; female prurigo; and elderly with prolonged pruritic atypical dermatoses or vesicular/bullous presentations should be kept in mind as clinical scenarios that may contribute to a delay in the diagnosis of scabies.

Anahtar Kelimeler

Scabies, pruritus, differential diagnosis, histopathological analysis, immunofluorescence microscopy

Zor Tanınan Skabiyez Olgularının Retrospektif Değerlendirilmesi: Klinik ve Epidemiyolojik Özellikler ve Diğer Dermatolojik Durumlarla Benzerliği

Öz

Arka Plan ve Amaç: Akarların neden olduğu bir deri hastalığı olan skabiyezin (uyuz) tanısı, diğer dermatolojik hastalıklara benzemesi nedeniyle zor olabilir. Yanlış teşhislerden kaçınmak, tedavi gecikmelerinde ve komplikasyonlarda önemli bir azalmaya neden olabilir. Amacımız başlangıçta tanısal zorluklar yaratan uyuz vakalarını araştırmaktı.
Yöntem: Bu retrospektif çalışma, rutin klinik muayenelere rağmen başlangıçta yanlış tanı konulan ve farklı dermatolojik ön tanılarla histopatolojik inceleme yapılan uyuz hastalarına odaklandı. Dahil etme kriterlerinde, 2020 Uluslararası Uyuz Kontrolü İttifakı Tanı Kriterlerine uyuldu. Çalışma klinik, histopatolojik ve demografik özellikleri retrospektif olarak derleyerek, diğer dermatolojik durumları taklit eden uyuz vakalarının teşhisindeki zorluklara ve gecikmelere veri sundu.
Bulgular: Tanı güçlüğü çeken 27 uyuz vakasından oluşan bir kohortta çoğunluğu kadın (%63) ve yaş ortalaması 64,8±15,9 yıl idi. Başvuru öncesi hastaların %66,7'si sistemik antihistaminik, %52,4'ü immünsupresan ve %42,9'u topikal uyuz tedavisi kullanmıştı. Vakaların sırasıyla %11,1'inde ve %7,4'ünde sekonder kserozis kutis ve kontakt dermatit kaydedildi. Dermatologlar tarafından en sık dikkate alınan ayırıcı tanılar prurigo subakuta (%29,6), dermatitis herpetiformis (%18,5), lenfomatoid papüloz (%14,8) ve veziküler/büllöz pemfigoid (%11,1) idi.
Sonuç: Önceki tedaviler; prurigo subakuta, kontakt dermatit ve kserotik egzama gibi şiddetli sekonder dermatolojik sorunlara yol açan uzun süreli enfestasyonlar; lezyonların atipik dağılımı; kadın prurigosu; ve uzamış kaşıntılı atipik dermatozları veya veziküler/büllöz prezentasyonları olan yaşlılar, skabiyez tanısının gecikmesine katkıda bulunabilecek klinik senaryolar olarak akılda tutulmalıdır.

Anahtar Kelimeler

Skabiyez, pruritus, ayırıcı tanı, histopatolojik analiz, immünfloresan mikroskopi

Kaynakça

• 1. Walton SF, Holt DC, Currie BJ, Kemp DJ. Scabies: new future for a neglected disease. Advances in parasitology 2004;57(57):309-376.
• 2. Centers for Disease Control and Prevention [Internet]. Scabies. [cited 2023 Oct 13]. Available from: https://www.cdc.gov/parasites/scabies/health_professionals/institutions.html.
• 3. Thomas C, Coates SJ, Engelman D, Chosidow O, Chang AY. Ectoparasites: Scabies. Journal of the American Academy of Dermatology 2020;82(3):533-548.
• 4. Chandler DJ, Fuller LC. A review of scabies: an infestation more than skin deep. Dermatology 2019;235(2):79-90.
• 5. Raffi J, Suresh R, Butler DC. Review of scabies in the elderly. Dermatology and Therapy 2019;9:623-630.
• 6. Ansarin H, Jalali MHA, Setarehshenas R, Mazloomi S, Soltani-Arabshahi R. Scabies presenting with bullous pemphigoid-like lesions. Dermatology online journal 2006;12(1).
• 7. Sunderkötter C, Wohlrab J, Hamm H. Scabies: epidemiology, diagnosis, and treatment. Deutsches Ärzteblatt International 2021;118(41):695.
• 8. World Health Organization [Internet]. Scabies. [cited 2023 Oct 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/scabies.
• 9. Bailiff OA, Mowad CM. Mimics of Dermatitis. Immunol Allergy Clin North Am 2021;41(3):493-515.
• 10. Walton SF, Currie BJ. Problems in diagnosing scabies, a global disease in human and animal populations. Clinical microbiology reviews 2007;20(2):268-279.
• 11. Currier RW, Walton SF, Currie BJ. Scabies in animals and humans: history, evolutionary perspectives, and modern clinical management. Annals of the New York Academy of Sciences 2011;1230(1):E50-E60.
• 12. Engelman D, Yoshizumi J, Hay R, Osti M, Micali G, Norton S, Walton S, Boralevi F, Bernigaud C, Bowen A. The 2020 international alliance for the control of scabies consensus criteria for the diagnosis of scabies. British Journal of Dermatology 2020;183(5):808-820.
• 13. Shoukat Q, Rizvi A, Wahood W, Coetzee S, Wrench A. Sight the Mite: A Meta-Analysis on the Diagnosis of Scabies. Cureus 2023;15(1):e34390.
• 14. Braun M, Yedidi RS, Raffi J, Butler DC, Murase JE. The challenge of diagnosing scabies in the elderly: A case and a novel therapeutic approach. International Journal of Women's Dermatology 2020;6(5):452.
• 15. Lugović-Mihić L, Delaš Aždajić M, Bešlić I. Scabies cases misdiagnosed and treated as allergic diseases: itch as alarm. Acta Clin Croat 2022;61(2):349-353.
• 16. Putra IB, Jusuf NK. Scabies with Secondary Infection Resembling Kerion-Type Tinea Capitis. Int J Gen Med 2021;14:163-167.
• 17. Bastian HM, Lindgren AM, Alarcón GS. Scabies mimicking systemic lupus erythematosus. Am J Med 1997;102(3):305-306.
• 18. Grau-Echevarría A, Labrandero-Hoyos C, Peñuelas-Leal R, Pérez-Ferriols A. Nodular scabies mimicking insect bites. Infection 2023.
• 19. Werbel T, Hinds BR, Cohen PR. Scabies presenting as cutaneous nodules or malar erythema: reports of patients with scabies surrepticius masquerading as prurigo nodularis or systemic lupus erythematosus. Dermatology online journal 2018;24(9).
• 20. Shin K, Jin H, You H-S, Kim J-M, Shim W-H, Kim G-W, Kim H-S, Ko H-C, Kim M-B, Kim B-S. Clinical characteristics of pruritus in scabies. Indian Journal of Dermatology, Venereology and Leprology 2017;83:492.
• 21. Li FZ, Jia M, Chen KJ, Ye Q, Fang S. Bullous Scabies: Clinical, Dermoscopic, and Pathologic Characteristics of Ten Patients. Am J Trop Med Hyg 2021;105(6):1798-1802.