Prolonged Post-Scabietic Pruritus: Clinical Characteristics and Unmet Management Needs in a Real-World Cohort

Background: Scabies is a highly contagious ectoparasitic skin infection that is considered a global public health problem. Treatment primarily focuses on mite eradication, but an inflammatory phase may persist despite successful therapy, known as post-scabietic pruritus (PSP). This study aimed to investigate the clinical features, duration, and severity of PSP in patients with persistent symptoms despite successful treatment. Methods: This cross-sectional descriptive study included 43 adult patients with dermoscopically documented scabies resolution, who reported pruritus persisting for more than 28 days. Demographic and clinical data, including clinical characteristics, treatment history, and pruritus severity assessed by the Visual Analogue Scale (VAS), were collected via structured questionnaires. Results: PSP persisted for 30-365 days, and 48.8% of patients experienced pruritus longer than 45 days. Pruritus severity in 72.1% of patients was reported as a VAS score ≥8. Nodular lesions were observed in 55.8% of patients. Sixteen patients (37.2%) had an atopic background, and nine patients (20.9%) reported a house dust mite (HDM) allergy. Heat, hot baths, and sweating were the most frequent aggravating factors. Despite persistent symptoms, 44.2% of patients reported not receiving any specific treatment after mite eradication. Conclusions: PSP can be prolonged and severe. Nodular lesions may be more frequent than previously reported. Eradication of the mite is the first step, and treatment is not complete until the post-treatment inflammatory phase is controlled.