Scabies in Children

Dermatology

Clinicals - History

Fact Explanation
Severe itching, worse at night. This is accompanied by skin lesions consisting of inflammatory cell infiltrates typical of a delayed type hypersensitivity immune reaction. Severe itching, worse at night.
This is accompanied by skin lesions consisting of inflammatory cell infiltrates typical of a delayed type hypersensitivity immune reaction.
Eruption of vesicles and papules. It is a consequence of both infestation and hypersensitivity to the mite. Eruption of vesicles and papules.
It is a consequence of both infestation and hypersensitivity to the mite.
A history of itching in other members of the family. Transmission occurs through direct skin to skin contact. A history of itching in other members of the family.
Transmission occurs through direct skin to skin contact.
Uncommonly, non itchy crusted lesions. Present in immunocompromised patients (Norwegian scabies), It is highly contagious due to the massive colonies of mites. Uncommonly, non itchy crusted lesions.
Present in immunocompromised patients (Norwegian scabies), It is highly contagious due to the massive colonies of mites.
A history of topical or systemic steroid treatment. Patient develops scabies incognito, a condition with symptoms much like that in immunocompromised patients. A history of topical or systemic steroid treatment.
Patient develops scabies incognito, a condition with symptoms much like that in immunocompromised patients.
In the infant and young child, the history suggests a more generalized rash, involving areas such as the head, neck, palms and soles. The parasite favors areas with a low concentration of pilosebaceous follicles and a thin stratum corneum. This seems to account for a difference in the distribution of the rash based on the age of the child, since this sort of skin is more widespread in the younger child. In the infant and young child, the history suggests a more generalized rash, involving areas such as the head, neck, palms and soles.
The parasite favors areas with a low concentration of pilosebaceous follicles and a thin stratum corneum. This seems to account for a difference in the distribution of the rash based on the age of the child, since this sort of skin is more widespread in the younger child.
Infants and young children give a history of poor feeding and daytime sleepiness. The child is constantly restless and irritable due to the itching and at night time this results in poor sleep. Infants and young children give a history of poor feeding and daytime sleepiness.
The child is constantly restless and irritable due to the itching and at night time this results in poor sleep.

Clinicals - Examination

Fact Explanation
Burrows, present as creeping, greyish lines. These are made by adult females as they digest and consume the epidermis.
Note: it is the classical diagnostic sign of scabies.
Burrows, present as creeping, greyish lines.
These are made by adult females as they digest and consume the epidermis.
Note: it is the classical diagnostic sign of scabies.
In infants, head, neck, palms and soles are involved with vesicles being most commonly found. There is a predisposition for vesicle formation in this age group. In infants, head, neck, palms and soles are involved with vesicles being most commonly found.
There is a predisposition for vesicle formation in this age group.
In older children, it involves the web spaces, flexures of arms and wrists, the axillae, etc. The parasite prefers areas of low concentration of sebaceous glands and thin stratum corneum. In older children, it involves the web spaces, flexures of arms and wrists, the axillae, etc.
The parasite prefers areas of low concentration of sebaceous glands and thin stratum corneum.
Scaly lesions in the skin, with associated lymphadenopathy. This is seen in Crusted (Norwegian) scabies; an entity that is most commonly associated with extreme incapacity and immunocompromised states. Scaly lesions in the skin, with associated lymphadenopathy.
This is seen in Crusted (Norwegian) scabies; an entity that is most commonly associated with extreme incapacity and immunocompromised states.
Golden crusted lesions (of impetigo), oozing lesions, etc. Due to secondary bacterial infection as a result of scratching.
This can lead to Glomerulonephritis and even acute rheumatic fever.
Golden crusted lesions (of impetigo), oozing lesions, etc.
Due to secondary bacterial infection as a result of scratching.
This can lead to Glomerulonephritis and even acute rheumatic fever.

Investigations - Diagnosis

Fact Explanation
Multiple superficial skin scrapings, to be viewed under light microscopy. Definitive diagnosis relies on the identification of mites, eggs, egg shell fragments, etc. Multiple superficial skin scrapings, to be viewed under light microscopy.
Definitive diagnosis relies on the identification of mites, eggs, egg shell fragments, etc.
Dermatoscopy. Diagnosis is by observing the “jet-with-contrail” pattern in the skin representing a mite and its burrow. Dermatoscopy.
Diagnosis is by observing the “jet-with-contrail” pattern in the skin representing a mite and its burrow.
Burrow ink test. This depends on the burrows absorbing ink. Burrow ink test.
This depends on the burrows absorbing ink.
Serological tests (specific IgE antibodies). Measuring levels of these antibodies to a major scabies antigen can help diagnose the disease with high sensitivity and specificity. Serological tests (specific IgE antibodies).
Measuring levels of these antibodies to a major scabies antigen can help diagnose the disease with high sensitivity and specificity.

Investigations - Management

Fact Explanation
Renal function tests. If there is secondary bacterial infection with group A Streptococcus, this could lead to acute glomerulonephritis and this could affect the pharmacological management. Renal function tests.
If there is secondary bacterial infection with group A Streptococcus, this could lead to acute glomerulonephritis and this could affect the pharmacological management.

Management - Supportive

Fact Explanation
Treat close contacts of the index case as well as the index case both at the same time. Close contacts may act as reservoirs of infection; therefore treating them would prevent reinfection of the index case following successful treatment. Treat close contacts of the index case as well as the index case both at the same time.
Close contacts may act as reservoirs of infection; therefore treating them would prevent reinfection of the index case following successful treatment.
Clothes and bed linen should be washed and dried the day after the first treatment. These items may harbor live mites. Clothes and bed linen should be washed and dried the day after the first treatment.
These items may harbor live mites.
Ensure adequate nutrition. Malnutrition predisposes individuals to crusted scabies. Ensure adequate nutrition.
Malnutrition predisposes individuals to crusted scabies.
Antihistamines and emollients. For symptomatic treatment of itch, including post-scabetic itch and itch caused by medication. Antihistamines and emollients.
For symptomatic treatment of itch, including post-scabetic itch and itch caused by medication.
Topical/ systemic antibiotics. When complicated by secondary bacterial infection. Topical/ systemic antibiotics.
When complicated by secondary bacterial infection.

Management - Specific

Fact Explanation
5% permethrin topical application. Infants: Should be applied to the skin of the entire body including the scalp, forhead and sides of the head. Older children: Should be applied from the Jaw line downwards. It is safe and efficacious in infants and children. (it is a pyrethroid that acts as an insecticide). In infants the head area is also affected. 5% permethrin topical application. Infants: Should be applied to the skin of the entire body including the scalp, forhead and sides of the head. Older children: Should be applied from the Jaw line downwards.
It is safe and efficacious in infants and children. (it is a pyrethroid that acts as an insecticide). In infants the head area is also affected.
5-10% sulfur topical application. Infants: Should be applied to the skin of the entire body including the scalp, forhead and sides of the head. Older children: Should be applied from the Jaw line downwards. It is safe and efficacious in infants and children. 5-10% sulfur topical application. Infants: Should be applied to the skin of the entire body including the scalp, forhead and sides of the head. Older children: Should be applied from the Jaw line downwards.
It is safe and efficacious in infants and children.
Oral Ivermectin. It interrupts glutamate-induced and gamma-aminobutyric acid-induced neurotransmission in parasites, leading to their paralysis and death. It is used to treat children with crusted scabies. Oral Ivermectin.
It interrupts glutamate-induced and gamma-aminobutyric acid-induced neurotransmission in parasites, leading to their paralysis and death. It is used to treat children with crusted scabies.
1% Lindane- not used in children. It has a high potential for causing neurologic toxicity. 1% Lindane- not used in children.
It has a high potential for causing neurologic toxicity.

Concise, fact-based medical articles to refresh your knowledge

Access a wealth of content and skim through a smartly presented catalog of diseases and conditions.

  1. BARBARA G. et al. Transmission of Scabies in a Newborn Nursery. Infection Control and Hospital Epidemiology [online]. May 2011, Vol. 32,(5) : 516-517 [viewed 5 March 2014]. Available from: DOI: 10.1086/659954
  2. CHOSIDOW Olivier. Scabies. New England Journal of Medicine. [online].April 2006, 354:1718-1727. [viewed 3 March 2014]. Available from: DOI:10.1056/NEJMcp052784
  3. FITZGERALD Deirdre, Rachel GRAINGE and Alex REID. Interventions for preventing the spread of infestation in close contacts of people with scabies. Cochrane Database of Systematic Reviews [online]. 2014, Issue 2. Art. No.: CD009943.[viewed 3 March 2014] Available from: DOI: 10.1002/14651858.CD009943.pub2.
  4. HURWITZ Sidney. Scabies in Childhood. Pediatrics in Review [online] September 1979, Vol. 1(3) 91 -94 [viewed 5 March 2014]. Available from: doi: 10.1542/pir.1-3-91
  5. JAYARAJ R., et al. A diagnostic test for scabies: IgE specificity for a recombinant allergen of Sarcoptes scabiei. Diagn microbiol infect dis. [online]. December 2011, (4): 403-7. [viewed 4 March 2014]. Available from: doi: 10.1016/j.diagmicrobio.2011.09.007
  6. KARTHIKEYAN Kaliaperumal. Scabies in children. ADC Education and Practice Edition [online] 2007, vol.92: ep65-ep69 [viewed 3 March 2014] Available from: doi:10.1136/adc.2005.073825
  7. McCARTHY J. S., et al. Scabies: more than just an irritation. Postgraduate Medical Journal [online] 2004 vol. 80: 382-387 [viewed 3 March 2014] Available from: doi:10.1136/pgmj.2003.014563
  8. PATEL, Anita, Peter HOGAN. and Brien WALDER. Crusted scabies in two immunocompromised children: Successful treatment with oral ivermectin. Australasian Journal of Dermatology [online]. 1999, 40: 37–40. [viewed 5 March 2014] Available from: doi: 10.1046/j.1440-0960.1999.00314.x
  9. PRUKSACHATKUNAKORN C., M. DAMRONGSAK and S. Sinthupuan. Sulfur for Scabies Outbreaks in Orphanages. Pediatric Dermatology [online] 2002, 19: 448–453. [viewed 5 March 2014]. Available from: doi: 10.1046/j.1525-1470.2002.00205.x
  10. SCHULTZ Margaret W., et al. Comparative Study of 5% Permethrin Cream and 1% Lindane Lotion for the Treatment of Scabies. Arch Dermatol. [online]. 1990, 126(2):167-170. [viewed 5 March 2014]. Available from: doi:10.1001/archderm.1990.01670260037006.
  11. STRONG Mark and Paul JOHNSTONE. Interventions for treating scabies. Cochrane Database of Systematic Reviews [online] 2007, Issue 3. Art. No.: CD000320. [viewed 3 March 2014] Available from: DOI: 10.1002/14651858.CD000320.pub2.
  12. TAPLIN David, et al. Comparison of Crotamiton 10% Cream (Eurax) and Permethrin 5% Cream (Elimite) for the Treatment of Scabies in Children. Pediatric Dermatology [online]. 1990, vol 7: 67–73. [viewed 5 March 2014]. Available from: doi: 10.1111/j.1525-1470.1990.tb01078.x
  13. WALTON Shelley F. and Bart J. CURRIE. Problems in Diagnosing Scabies, a Global Disease in Human and Animal Populations. Clinical Microbiology Reviews. [online]. April 2007, vol. 20 no. 2 268-279. [viewed 3 March 2014]. Available from: doi: 10.1128/CMR.00042-06