A Neglected Disease: Scabies a Retrospective Study On Children

Abstract

Objective: Scabies is one of the diseases that can be minimized with preventive health measures. Accurate diagnosis of scabies is important for both patient and public health. Diagnosis of scabies in children can be challenging, since the clinical features in children may differ from those of adults. The aim of the present study was to investigate the demographic and clinical characteristics of the patients with scabies in childhood.

Material and Methods: The patients aged 0-18 years, who were diagnosed with scabies and presented to the dermatology outpatient clinic of our hospital, were included in the study. The demographic characteristics of the patients, time of admission, duration of symptoms, family history, the presence of specific lesions, and any lesions on the scalp, face, palmoplantar region, laboratory findings (if any), previous hospital admissions, treatment, and complications were recorded retrospectively.

Results: Fifty six of the 104 patients were male (53.8%) and 48 were female (46.2%). The mean age was 5.82±5.21 years. The mean duration of symptoms was 2.41±2.24 months. Eighty four patients had a family history of scabies (80.7%). Seventy patients (67.3%) had at least one specific lesion of scabies. Atypical sites of involvement were palmoplantar region (33.6%), head (6.7%), and face (2.8%). The most commonly used diagnostic tool was dermatoscopy. Forty-one patients were treated with permethrin 5% lotion (39.4%) and 63 with sulfur ointment (60.5%). Of all admissions to the hospital, admissions were highest in fall (40.4%), followed by winter (30.8%), summer (18.2%), and spring (10.6%). Eight patients developed complications (7.6%), including 5 with impetigo and 3 with paronychia.

Conclusion: Scabies is an important health issue that can be treated with an accurate and prompt diagnosis. It was observed that the head, face, palms, and soles often are involved in infants and very young children, unlike adults. Therefore, clinicians should consider the clinical differences between adults and children in the management of scabies in children. Also, dermatoscopy is a practical and effective diagnostic tool especially in infants and young children with scabies.

Keywords

• childhood
• dermatoscopy
• scabies

İhmal Edilen Bir Hastalık: Uyuz, Çocuklar Üzerine Retrospektif Bir Çalışma

Abstract

Amaç: Skabiyes, koruyucu sağlık önlemleri ile azaltılabilecek hastalıklardandır. Skabiyesin doğru teşhisi, hem hasta hem de halk sağlığı için önemlidir. Skabiyesin çocuklardaki klinik özellikleri yetişkinlerden farklı olabileceğinden çocuklarda skabiyes tanısı zor olabilir. Bu çalışma ile çocukluk çağında saptanan skabiyes olgularının demografik ve klinik özelliklerin araştırılması amaçlandı.

Gereç ve Yöntemler: Hastanemiz dermatoloji polikliniklerine başvuran, 0-18 yaş arası skabiyes tanısı alan hastalar çalışmaya dahil edildi. Hastaların demografik özellikleri, başvuru zamanı, semptomların süresi, aile hikayesi, spesifik lezyon varlığı, saçlı deri, yüz, palmoplantar bölgede lezyon varlığı, varsa laboratuar bulguları, önceki hastane başvurusu, tedavi ve komplikasyon gelişimi retrospektif olarak kaydedildi.

Bulgular: Yüz dört hastanın 56’si erkek (%53.8), 48’i kızdı (%46.2). Yaş ortalaması 5.82±5.21 yıldı. Hastaların ortalama semptom süresi 2.41±2.24 aydı. Seksen dört olgunun aile hikayesi vardı (%80.7). Yetmiş hasta en az bir spesifik lezyona sahipti (%67.3). Atipik tutulum bölgeleri palmoplantar bölge (%33.6), baş (%6.7) ve yüz (%2.8)’di. En sık kullanılan tanısal araç dermatoskopiydi. Kırk bir olgu permetrin %5 losyon (%39.4) ile 63 olgu sülfürlü merhemle (%60.5) tedavi edildi. Hastaneye yapılan başvuruların en yüksek olduğu dönem sonbahar (%40.4), ardından kış (%30.8), yaz (%18.2) ve ilkbahardı (%10.6). Beşi impetigo ve 3’ü paronişi olmak üzere 8 hastada komplikasyon (%7.6) gelişti.

Sonuç: Skabiyes, doğru ve hızlı bir tanı ile tedavi edilebilen önemli bir sağlık sorunudur. Yetişkinlerin aksine baş, yüz, avuç içi ve ayak tabanlarının sıklıkla bebeklerde ve çok küçük çocuklarda tutulduğu görülmüştür. Klinisyenler, çocuklarda skabiyesin yönetiminde erişkinler ve çocuklar arasındaki klinik farklılıkları dikkate almalıdır. Ayrıca dermatoskopi özellikle skabiyesli bebekler ve küçük çocuklarda pratik ve etkili bir tanı aracıdır.

Keywords

• çocukluk çağı
• skabiyes
• dermatoskopi

References

1. 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;32:373-80.
2. Hicks MI, Elston DM. Scabies. Dermatologic Therapy 2009;22:279-92.
3. Engelman D, Cantey PT, Marks M, Solomon AW, Chang AY, Chosidow O, et al. The public health control of scabies: priorities for research and action. Lancet (London, England) 2019;394:81-92. World Health Organization. Neglected tropical diseases: Scabies 2020.
4. Baykal C, Atci T, Kutlay A, Baykut B , Türkoğlu Z. Scabies outbreak in Turkey in 2018-2019. Journal of the European Academy of Dermatology and Venereology : JEADV 2021.
5. Thomas C, Coates SJ, Engelman D, Chosidow O , Chang AY. Ectoparasites: Scabies. J o Am Acad Dermatol 2020;82:533-48.
6. Sardana K, Mahajan S, Sarkar R, Mendiratta V, Bhushan P, Koranne RV, et al. The spectrum of skin disease among Indian children. Pediatric Dermatol 2009;26:6-13.
7. Hay RJ, Steer AC, Engelman D , Walton S. Scabies in the developing world--its prevalence, complications, and management. Clin Microbiol Infect 2012;18:313-23.
8. Çetinkaya Ü, Şahin S, Ulutabanca R. The Epidemiology of Scabies and Pediculosis in Kayseri. Turkiye Parazitol Derg 2018;42:134-7.

9. Turan Ç, Metin N, Utlu Z. Epidemiological Evaluation of Scabies Cases Encountered in the Last Three Years as a Tertiary Health Center. Turkiye Parazitol Derg 2020;44:77-82.
10. Aktaş H, Cebecik A. Changes in Incidence and Age Distribution of Scabies: A Retrospective Cohort Study in A Tertiary Hospital. Arch Clin Exp Med 2019;4:21-4.
11. 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:e818-e20.
12. Wilson MM, Philpott CD , Breer WA. Atypical presentation of scabies among nursing home residents. J Gerontol A Biol Sci Med Sci 2001;56:M424-7.
13. Chosidow O. Scabies and pediculosis. Lancet (London, England) 2000;355:819-26.
14. Engelman D, Yoshizumi J, Hay RJ, Osti M, Micali G, Norton S, et al. The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies. Br J Dermatol 2020;183:808-20.
15. Srinivas S, Herakal K, Murthy S, Suryanarayan S. Dermoscopic study of scabies in children. Indian J Paediatr Dermatol 2019;20:46-51.
16. Walter B, Heukelbach J, Fengler G, Worth C, Hengge U, Feldmeier H. Comparison of dermoscopy, skin scraping, and the adhesive tape test for the diagnosis of scabies in a resource-poor setting. Arch Dermatol 2011;147:468-73.
17. Mimouni D, Ankol OE, Davidovitch N, Gdalevich M, Zangvil E, Grotto I. Seasonality trends of scabies in a young adult population: a 20-year follow-up. Br J Dermatol 2003;149:157-9.
18. Sluzevich JC, Sheth AP, Lucky AW. Persistent eosinophilia as a presenting sign of scabies in patients with disorders of keratinization. Arch Dermatol 2007;143:670-3.
19. 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;14:1155-67.
20. Porto I. Antiparasitic drugs and lactation: focus on anthelmintics, scabicides, and pediculicides. J Hum Lact 2003;19:421-5.
21. Salavastru CM, Chosidow O, Boffa MJ, Janier M, Tiplica GS. European guideline for the management of scabies. J Eur Acad Dermatol Venereol 2017;31:1248-53.
22. Romani L, Steer AC, Whitfeld MJ, Kaldor JM. Prevalence of scabies and impetigo worldwide: a systematic review. Lancet Infect Dis 2015;15:960-7.
23. Kaburi BB, Ameme DK, Adu-Asumah G, Dadzie D, Tender EK, Addeh SV, et al. Outbreak of scabies among preschool children, Accra, Ghana, 2017. BMC Public Health 2019;19:746.