Pediatric Scabies 

  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 5, 2011
 

Background

Scabies is a common infestation in the pediatric population caused by the arthropod Sarcoptes scabiei. The mite is transmitted via prolonged direct human contact and rarely by fomites. The adult female mite is 0.3-0.5 mm long and has 4 pairs of legs. The term scabies is believed to be derived from the Latin term scabere, which means to scratch, or possibly from the term scabs, which are secondary to bacterial infection.

The photographs below depict various presentations of scabies.

In patients with scabies, erythematous vesicles anIn patients with scabies, erythematous vesicles and papules are present on torso extremities, some with adjacent linear excoriations. Courtesy of Audra Malerba, DO. Scabies on hand. Courtesy of William D. James, MD.Scabies on hand. Courtesy of William D. James, MD. Norwegian scabies. Courtesy of William D. James, MNorwegian scabies. Courtesy of William D. James, MD. Scabies on leg. Courtesy of William D. James, MD. Scabies on leg. Courtesy of William D. James, MD. Scabies on buttocks. Courtesy of William D. James,Scabies on buttocks. Courtesy of William D. James, MD. Scabies on penis. Courtesy of William D. James, MDScabies on penis. Courtesy of William D. James, MD. Scabies on penis. Courtesy of Hon Pak, MD. Scabies on penis. Courtesy of Hon Pak, MD.
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Pathophysiology

The skin is the main organ involved in scabies. The lesion is caused by the gravid female mite burrowing beneath the stratum corneum. She leaves behind a trail of debris, eggs, and feces (scybala), which induces an immunologic response. The female can lay as many as 90 eggs in her 30-day lifespan. The larvae hatch in 3-4 days; they mature to adult forms over the next 2 weeks and continue the cycle. The average patient is infected with 10-15 live adult female mites at any given time.

Pruritus, the main clinical manifestation, is caused by hypersensitivity to the debris, eggs, and feces, rather than by the direct effects of the mite. The primary lesions appear 3-10 days after exposure to the mite. These lesions include burrows, papules, vesicles, and pustules. The rash usually becomes intensely pruritic several days later because the immune system requires time to mount a hypersensitive response. Nocturnal pruritus is characteristic of scabies infestation. An immunologic study analyzing the cellular infiltrate types and patterns in lesions of scabies concluded that T4 cell dominance is the cause of persistent itching and T8 increase leads to improvement in the pruritus.[1]

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Epidemiology

Frequency

United States

Scabies may be observed in people of all ages and is not always a disease of overcrowding. Norwegian (crusted) scabies is observed in patients who are immunocompromised, human immunodeficiency virus (HIV) positive, or institutionalized.

International

A survey of children in a welfare home in Pulau Pinang, Malaysia found that the infestation rate for scabies was highest among children aged 10-12 years.[2] Scabies was more commonly evident in boys (50%) than girls (16%). The overall prevalence rate for scabies was 31%.

Of 200 dermatology outpatients in Sirte, Libya with scabies, the following distribution was found:[3]

  • Females - 59%
  • Children - 37.5%
  • Military personnel - 18%

Mortality/Morbidity

Intense pruritus is the major morbidity associated with scabies. This often leads to excoriation and secondary bacterial infection.

Skin disease is among the most frequent causes of morbidity in impoverished sections of Ethiopia; in one study, scabies was the leading cause of hospital admission.[4]

Race

No racial predisposition to acquiring scabies has been noted.

Age

Scabies can infect people of all age groups from infancy to adulthood.

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Contributor Information and Disclosures
Author

Camila K Janniger, MD  Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Giuseppe Micali, MD  Head, Professor, Department of Dermatology, University of Catania School of Medicine, Italy

Giuseppe Micali, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Mudra Kumar, MD, MBBS, MRCP  Associate Professor, Department of Pediatrics, University of South Florida College of Medicine

Mudra Kumar, MD, MBBS, MRCP is a member of the following medical societies: American Academy of Pediatrics and American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

Kevin P Connelly, DO  Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Scabies mite. Courtesy of William D. James, MD.
Scabies mite scraped from a burrow (400 X). Courtesy of Audra Malerba, DO.
Scabies. Courtesy of William D. James, MD.
In patients with crusted scabies, sections show multiple mites (arrows) within the hyperkeratotic stratum corneum. The epidermis is spongiotic (hematoxylin and eosin [H&E], 100 X). Courtesy of Audra Malerba, DO.
In patients with routine scabies, a single mite is observed. Eosinophilic spongiosis may be present (hematoxylin and eosin [H&E], 400 X). Courtesy of Audra Malerba, DO.
In patients with scabies, erythematous vesicles and papules are present on torso extremities, some with adjacent linear excoriations. Courtesy of Audra Malerba, DO.
Scabies on hand. Courtesy of William D. James, MD.
Norwegian scabies. Courtesy of William D. James, MD.
Scabies on leg. Courtesy of William D. James, MD.
Scabies on buttocks. Courtesy of William D. James, MD.
Scabies on penis. Courtesy of William D. James, MD.
Scabies on penis. Courtesy of Hon Pak, MD.
 
 
 
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