Tuscany consensus for pediatric scabies: update on clinical management and the urgent need for new guidelines

The aim of this study was to assess the degree of agreement among pediatric dermatologists in Tuscany concerning different aspects of scabies infestation management in children, employing the Delphi method.

We conducted a Delphi study involving ten pediatric dermatology centers in Tuscany, Italy. Questionnaires were distributed to a panel of experts anonymously. The questionnaires were organized into six specific topics: "diagnosis," "hygiene measures," "application of topical products," "treatment," "treatment of exposed individuals," and "clinical follow-up after therapy." Each question within these topics offered six different response options.

All participating dermatologists completed the two-round questionnaire. Full consensus was reached for all statements related to "diagnosis," "hygiene measures," "treatment of exposed individuals," "application of topical products," and "clinical follow-up after therapy," since each statement met the predetermined consensus threshold of 70% or higher. However, we could not achieve a substantial consensus on the treatment of scabies, aside from agreement on the lower efficacy of permethrin therapy.

Considering the growing recognition of Sarcoptes scabiei resistance to conventional permethrin therapy, this regional consensus offers clear insights into the overall management of scabies. However, it also reveals that each dermatologist primarily relies on their own experiences for medical treatment, which may not be universally shared among colleagues. This emphasizes the urgent necessity for updated guidelines on therapeutic strategies.