Scabies is considered by the WHO to be one of the main neglected diseases with approximately 300 million cases worldwide each year. One third of cases of scabies seen by dermatologists are in kids less than 16 years old. The belief had been that presentation varies by age. One French study reported a first time miss rate of more than 41% and an overall diagnostic delay of 62 days.
A prospective, multi center observational study of patients with confirmed scabies sought to determine common phenotypes in children. All patients were seen by dermatologists in France and administered standard questionnaires. They were divided into 3 age groups, <2 years, 2-15 years and > 15 years. 323 patients were included.
The study found that: -infants were more likely to have facial involvement and nodules, especially on the back and axilla -relapse was more common in < 15 year olds - this was hypothesized to be due to poor compliance with treatment to the head -family members with itch, or planter or scalp involvement were independently associated with diagnosis of scabies in kids < 2 years -burrows were seen in 78%, nodules in 67% and vesicles of 43% of patients (see photo) -itching was absent in up to 10% of patients
Bottom line: Have a high suspicion for scabies in any rash.
References
Boralevi et al. Clinical phenotype of scabies by age. Pediatics. Volume 133. No 4. April 2014. 910-916.
