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Beyond the standard: targeted reapplication in palmoplantar scabies of infants
Martina Mussi1,2, Corrado Zengarini1,2, Gionathan Orioni1,2
1Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola Malpighi, Bologna, Italy.
Insights
Treating infantile scabies is difficult. An intensified topical permethrin regimen targeting hands and feet achieved 100% resolution in infants, unlike the standard approach.
Area of Science:
- Dermatology
- Pediatrics
- Parasitology
Background:
- Infantile scabies presents unique treatment challenges.
- Behavioral and anatomical factors in infants limit topical therapy efficacy.
- Persistent palmar-plantar scabies requires optimized treatment strategies.
Purpose of the Study:
- To evaluate an intensified topical permethrin regimen for infantile scabies.
- To compare treatment outcomes between standard and intensified regimens.
- To address the challenges of topical therapy in neonates and infants.
Main Methods:
- A prospective cohort study involving 22 infants with persistent palmar-plantar scabies.
- Patients received permethrin 5% cream.
- Intervention group: intensified regimen with targeted nightly applications to hands/feet.
- Control group: standard topical regimen.
Main Results:
- Complete resolution in 100% of infants (11/11) receiving the intensified regimen.
- Zero resolution (0/11) in the control group receiving the standard regimen.
- Infant movements and fist clenching likely reduce topical drug contact time.
Conclusions:
- Standard topical scabies regimens may be insufficient for infants.
- Targeted reapplication of permethrin cream to hands and feet improves outcomes.
- Caregiver education is crucial for optimizing infantile scabies treatment.
Abstract:
Infantile scabies can be challenging to treat because of behavioural and anatomical factors that reduce the efficacy of topical therapies. In this small prospective cohort study, there were 22 neonates and infants with persistent palmoplantar scabies. Patients were treated exclusively with permethrin 5% cream. All patients initially failed the standard regimen consisting of one full-body application, followed by a second -application after 7 days. In 1 group, 11 infants received an intensified regimen with 3 additional nights of targeted application to the hands and feet (intervention group), while in a second group, 11 continued with the standard regimen only (control group). Complete resolution was observed in all 11 patients in the intervention group, compared with none in the control group. Frequent infant behaviours, including spontaneous kicking, leg movements and habitual fist clenching, probably reduced drug contact time on the palms and soles. These findings indicate that standard topical regimens may be insufficient in this population and that targeted reapplication, combined with caregiver education, can optimize treatment outcomes in infants.
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