Frequency of Scabies in Pediatric Allergy Clinic and Evaluation of Demographic Characteristics of Affected Patients

Abstract

Objective: There has been an increase in the number of cases as pediatricians mistakenly refer scabies to an allergy clinic, misdiagnosing it as allergic illnesses, particularly atopic dermatitis (AD), because of the presence of symptoms such as itching and eczematous lesions. The objective of our study was to examine the prevalence of scabies in children who were referred to the pediatric allergy clinic after being misdiagnosed with AD. We also aimed to determine the clinical and demographic distinctions between individuals with AD and scabies. Methods: The files of 610 patients those referred to Sakarya Training and Research Hospital Pediatric Allergy Clinics between February-December 2022 with complaints of 'itching and rash' were documented retrospectively. Cases of acute urticaria, chronic urticaria, mastocytosis, insect bite, maculopapular rash with viral infection, drug-induced reactions were excluded. Patients whose final diagnosis was AD and who were diagnosed with 'definite scabies' were included in the study. Results: A total of 404 patients were included in the study. The rate of definite diagnosis of scabies was 18.5% (n:75/404). The median age at presentation was 19 months (IQR 8-51) in patients diagnosed with AD and 53 months (IQR 17-117) in patients diagnosed with scabies (p<0.005). The median time from symptom onset to diagnosis was seven months (IQR 2.5-24) in the AD group and two months (IQR 1-4) in the scabies group (p<0.005). Only 20% (n:15/75) of patients with scabies had family history, 16% of patients (n:12/75) had received one or more treatments before. Pruritis was present in only 72% (54/75) of children. Hospitalization rate was 0.05% (n:4/75). Conclusion: We recommend that scabies should be considered as a potential diagnosis for patients who visit to any clinic with symptoms of itching and a skin rash. Timely identification and medical intervention for scabies in children is crucial in order to minimize the spread of the disease throughout the community and prevent potential complications.

Keywords

• scabies
• atopic dermatitis
• allergy

References

1. Scott GR, Chosidow O; IUSTI/WHO. European guideline for the management of scabies, 2010. Int J STD AIDS. 2011; 22(6): 301-3. doi: 10.1258/ijsa.2011.011112.
2. Schneider S, Wu J, Tizek L et al. Prevalence of scabies worldwide-An updated systematic literature review in 2022. J Eur Acad Dermatol Venereol. 2023; 37(9): 1749-1757. doi: 10.1111/jdv.19167.
3. Özden MG, Ertürk K, Kartal SP et al. An extraordinary outbreak of scabies in Turkey. J Eur Acad Dermatol Venereol. 2020; 34(12): e818-e820. doi: 10.1111/jdv.16699.
4. Karthikeyan K. Scabies in children. Arch Dis Child Educ Pract Ed. 2007; 92(3): ep65-9. doi: 10.1136/adc.2005.073825.
5. Thompson R, Westbury S, Slape D. Paediatrics: how to manage scabies. Drugs Context. 2021; 10:2020-12-3. doi: 10.7573/dic.2020-12-3.
6. Lugović-Mihić L, Delaš Aždajić M, Bešlić I. Scabıes cases mısdıagnosed and treated as allergıc dıseases: ıtch as alarm. Acta Clin Croat. 2022; 61(2): 349-353. doi: 10.20471/acc.2022.61.02.22.
7. Engelman D, Yoshizumi J, Hay RJ et al. The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies. Br J Dermatol. 2020; 183(5): 808-820. doi: 10.1111/bjd.18943.
8. Betlloch-Mas I, Boluda-Verdú E, Jara-Rico N, Sánchez-García V, Berbegal-De Gracia L, Chiner-Vives E. Scabies in Infants: Series of 51 Cases. Children (Basel). 2024 Apr 7;11(4):443.

9. Turan, Çağrı, Nurcan Metin, and Zeynep Utlu. "Üçüncü Basamak Sağlık Merkezi Olarak Son Üç Yılda Karşılaşılan Skabiyez Olgularının Epidemiyolojik Değerlendirilmesi." Türkiye Parazitolojii Dergisi 44.2 (2020): 77.
10. Sunderkötter C, Wohlrab J, Hamm H. Scabies: Epidemiology, Diagnosis, and Treatment. Dtsch Arztebl Int. 2021; 118(41): 695-704. doi: 10.3238/arztebl.m2021.0296.
11. Grodner C, Miquel J, Hadj-Rabia S, Mallet S, Boralevi F, Mazereeuw-Hautier J, Benzebouchi N, Dhers M, Goujon E, Bensaïd P, Mahé E. Crusted scabies in children in France: a series of 20 cases. Eur J Pediatr. 2022 Mar;181(3):1167-1174.
12. Özçelik, Sinan. "A Neglected Disease: Scabies a Retrospective Study On Children." Turkish Journal of Pediatric Disease. 16.2 (2022): 121-126.
13. Arslan H. Çocuklar alerjik değilse neden kaşınır? Bostancı İ, editör. Çocuk Sağlığında Pratik Alerji Yaklaşımları. 1. Baskı. Ankara: Türkiye Klinikleri; 2021. p.47-54.
14. Gilson RL, Crane JS. Scabies. 2023 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
15. Napolitano M, Fabbrocini G, Martora F et al. Children atopic dermatitis: Diagnosis, mimics, overlaps, and therapeutic implication. Dermatol Ther. 2022; 35(12): e15901. doi: 10.1111/dth.15901.
16. Cohen L, Seminario-Vidal L, Lockey RF. Dermatologic Problems Commonly Seen by the Allergist/Immunologist. J Allergy Clin Immunol Pract. 2020; 8(1): 102-112. doi: 10.1016/j.jaip.2019.07.019.
17. Anderson KL, Strowd LC. Epidemiology, Diagnosis, and Treatment of Scabies in a Dermatology Office. J Am Board Fam Med. 2017; 30(1): 78-84. doi: 10.3122/jabfm.2017.01.160190.
18. Tasani M, Tong SY, Andrews RM et al. The Importance of Scabies Coinfection in the Treatment Considerations for Impetigo. Pediatr Infect Dis J. 2016; 35(4): 374-378. doi: 10.1097/INF.0000000000001013.
19. Mbuagbaw L, Sadeghirad B, Morgan RL et al. Failure of scabies treatment: a systematic review and meta-analysis. Br J Dermatol. 2023: ljad308. doi: 10.1093/bjd/ljad308.
20. Aksoy FD, Hacımustafaoğlu MK. Bebek ve çocukta scabies tedavisinde majistral ilaçları nasıl kullanmalıyız? J Pediatr Inf 2023;17(4):294-295.
21. Kazan D, Odyakmaz E. Skabiyes; klinik bulgular, tanı ve tedavi. Acta Medica Nicomedia 3.2 (2020): 80-87.