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Factors Affecting Topical Treatment Success in Pediatric Scabies Cases: A Cross-Sectional Study
Muazzez Cigdem Oba1, Defne Ozkoca2, Rana Basara Sahin3
1Department of Dermatology, Health Sciences University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey.
Insights
Topical scabies treatment in children often fails. Success depends on treating all household members, consulting dermatologists, and avoiding permethrin, especially for children with atopy.
Area of Science:
- Dermatology
- Pediatrics
- Infectious Diseases
Background:
- Scabies is a prevalent parasitic skin infection in children.
- Pediatric scabies treatment frequently results in failure and relapse.
Purpose of the Study:
- To identify key factors influencing the success of topical scabies treatment in pediatric patients.
- To understand the reasons behind treatment failure and relapse in children with scabies.
Main Methods:
- A multicenter, cross-sectional study involving 170 pediatric scabies cases.
- Patients were categorized into treatment failure (TF) and treatment success (TS) groups.
- Data collected included patient demographics, treatment agents, application methods, and household member symptoms.
Main Results:
- Treatment failure was associated with symptomatic household members, referrals from non-dermatologists, and incorrect topical application (e.g., single or local application, not treating contacts).
- Permethrin use was linked to higher treatment failure rates, while sulfur preparations were more common in successful treatments.
- Factors positively associated with treatment success included atopy, absence of symptomatic household members, and consultation with a dermatologist.
Conclusions:
- Effective pediatric scabies management requires treating all infested individuals simultaneously and considering alternative topical agents to permethrin.
- Improving scabies awareness and treatment protocols among non-dermatologists is crucial for better outcomes.
Introduction:
Scabies is a common disease that affects the pediatric population. Treatment failure and relapse occur frequently in children.
Objectives:
We aimed to identify the factors that affect topical treatment success in pediatric scabies patients.
Methods:
A multicenter cross-sectional study was conducted from April 2022 to December 2022. Pediatric scabies cases were classified as belonging to either the treatment failure (TF) group or the treatment success (TS) group.
Results:
We enrolled 170 patients for the study. In the TF group, the presence of symptomatic household members and referrals from physicians other than dermatologists were more common (both P < 0.001), and relapse rates and total symptom duration were higher (P = 0.007, P < 0.001, respectively). Regarding treatment agents, 5% permethrin was more commonly used in the TF group (71.1% versus 25%; P < 0.001). The proportion of patients treated with sulfur preparations was significantly higher in the TS group (60.7% versus 16.9%; P < 0.001). Misapplication of topical therapy was significantly more common in the TF group (P < 0.001), with statistically significant errors being (i) lack of treatment of close contacts (p<0,001), (ii) single application (P < 0.001), and (iii) local application (P = 0.027). A multivariate analysis revealed that TS was mainly associated with (i) the presence of atopy (odds ratio [OR] 6.12, 95% CI: 1.39-27.04), (ii) the absence of symptomatic household members (OR 6.31, 95% CI: 2.14-18.63), and (iii) presentation to a dermatologist rather than another specialist (OR 6.51, 95% CI: 2.11-20.13). The use of permethrin negatively affected treatment success (OR 0.22, 95% CI: 0.07-0.71).
Conclusions:
Pediatric scabies patients should be treated before other family members become infested and with topicals other than permethrin. In addition, awareness of scabies needs to be increased among non-dermatologists.
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