Scabies in infants and children - a narrative review

Area of Science:

• Dermatology
• Parasitology
• Public Health

Background:

• Scabies is a widespread ectoparasitic infection caused by *Sarcoptes scabiei* var. hominis, affecting approximately 300 million people worldwide.
• Infants and children are most frequently affected, with poverty and overcrowding exacerbating transmission and treatment challenges.
• The primary symptom is intense pruritus, leading to sleep disturbances and excoriations that can result in severe bacterial infections and mortality.

Purpose of the Study:

• To review the current understanding of scabies epidemiology, clinical presentation, diagnosis, and treatment.
• To highlight factors contributing to treatment failure and emerging challenges in scabies management.
• To provide an overview of novel therapeutic agents currently under development.

Main Methods:

• Clinical diagnosis remains primary, supported by dermoscopy for non-invasive visualization.
• Microscopy of skin scrapings is a sensitive diagnostic tool, while polymerase chain reaction (PCR) shows variable sensitivity and specificity.
• Review of current treatment guidelines and emerging pharmacological interventions.

Main Results:

• Topical permethrin 5% is the recommended first-line treatment, with oral ivermectin reserved for refractory cases or widespread outbreaks.
• Treatment failure is often linked to incorrect application or failure to treat asymptomatic household contacts.
• The COVID-19 pandemic and increased migration have been associated with a rise in scabies incidence.

Conclusions:

• Effective scabies management requires accurate diagnosis, appropriate treatment application, and addressing socio-environmental factors.
• Adherence to treatment protocols and managing asymptomatic carriers are crucial to prevent recurrence and resistance.
• Ongoing research into new scabicides offers promise for improved therapeutic options in the future.