Pediatric Scabies Workup

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

Laboratory Studies

The diagnosis of scabies can often be made clinically in patients with a pruritic rash and characteristic linear burrows.

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Other Tests

Definitive diagnosis of scabies is made by direct visualization of the mite, eggs, or feces. Mineral oil should be placed on the end of a burrow, preferably where a black dot is visible. The area should then be scraped with a number 5 scalpel blade, and the scrapings should be shed onto a slide. The mite can be visualized with low-power microscopy. In infants and young children, 75% of mites can be found on the hands and feet, making these the best sites to examine for burrows.

A simple, cheap, sensitive, and specific test for routine diagnosis of active scabies is desirable.[9] The expression and purification of S scabiei recombinant antigens have identified numerous molecules with diagnostic potential. Current studies are assessing the accuracy of these recombinant proteins in identifying antibodies in individuals with active scabies and in differentiating them from individuals with past exposure.

Skin scrapings using a conventional light microscope for direct visual identification of the mite may be used, or skin scrapings with amplification of S scabiei –specific DNA sequences by polymerase chain reaction may be obtained.

In vivo scabioscopy allows for the examination of numerous lesions in little time, thereby potentially increasing sensitivity. However, the mite is only vaguely distinguishable from crusts by its triangular silhouette corresponding to its mouth and 2 pairs of front legs.

Superficial cyanoacrylate biopsy (SCAB), combined with conventional transillumination light microscopy, is a recently advocated method that readily reveals the anatomic features of the scabies mite in detail. It can also distinguish living mites from dead mites because it removes the mites without harming them.[10] Scabies mites are shown below.

Scabies mite. Courtesy of William D. James, MD. Scabies mite. Courtesy of William D. James, MD. Scabies mite scraped from a burrow (400 X). CourteScabies mite scraped from a burrow (400 X). Courtesy of Audra Malerba, DO.

Dermoscopy, the microscopic examination of a skin scraping, and the adhesive tape test were compared in patients with a presumptive diagnosis of scabies.[11] The sensitivity of dermoscopy was 0.83, which was significantly higher than the sensitivity of the adhesive tape test. The latter was easy to perform and had high positive and negative predictive values that make it a good screening test. The sensitivity of skin scraping was judged to be low. Dermatoscopy-guided tape testing may be beneficial and should be evaluated.[12]

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Histologic Findings

The female mite is 0.3-0.5 mm in length and has a tortoise-shaped body with 4 pairs of very short legs, 2 pairs in front and 2 in back.

The mite also has spines on its dorsal surface.

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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.

References

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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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