Scabies

Abstract

Scabies is a skin condition of humans and animals caused by the mite, Sarcoptes scabiei. It is a significant public health concern worldwide regardless of socio-economic status. The most severe form (crusted/Norwegian) of scabies is re-emerging in the developed nations, especially among vagrants, institutionalized older population, individuals with intellectual disability and immunocompromised individuals. It is most commonly transmitted by direct skin contact from one person to another. However, it can also spread through sexual contact and even fomites. Infested individuals require prompt management because a misdiagnosis led to outbreaks, morbidity and an increased economic burden.

Case Study

A 12-year-old boy from a middle-income family was taken to a clinic with history of intense scratching on his body and scrotum over the last 20–21 days. The other members of the family have also endured scratching over the last 4–5 days. The boy’s parents had applied Betnovate ointment (0.1% betamethasone valerate) to the body of the patient. It briefly decreased itching for 2–3 days, but it recurred with severe itching. The papular lesions present on the groin of the child became nodular. With slight tenderness, his father developed crusted lesions.

• 1. What is the differential diagnosis of this case?

• 2. What investigations should be performed?

• 3. What treatment should be advocated?

• 4. What advice for prevention should be given?

Research Questions

• 1. What are the immunological events in skin and peripheral blood during scabies which may provide insights into immunological therapies?

• 2. What systematic, accurate and economical diagnostic approach should be developed for scabies that can be accessible in underdeveloped countries?

• 3. What is the optimal treatment modality?