Materiały źródłowe

• #1 Detection of scabies: A systematic review of diagnostic methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3222761/

  This study systematically reviewed the accuracy and precision of history, physical examination and tests for diagnosing scabies. […] History and examination of pruritic dermatoses failed to accurately diagnose scabies infection. […] The accuracy of dermatoscopy, performed by a trained practitioner, was determined; however, the accuracy of other diagnostic tests could not be calculated from the data in the literature. […] In the face of such diagnostic inaccuracy, research to identify or develop accurate diagnostic tests for scabies infection is needed and justifiable. […] Accurate diagnosis of scabies infection is important for patient treatment and for public health control of scabies epidemics. […] Diagnosis based on symptoms and an empirical trial of scabies treatment is problematic because it can lead to diagnostic error and frustration, as well as uncertainty when patients do not improve.

• #1

  https://www.who.int/news-room/fact-sheets/detail/scabies

  Diagnosis of scabies is based on clinical recognition of the typical features of infestation. The diagnosis of scabies can be supported by visual imaging techniques such as dermatoscopy or microscopy of skin scrapings from burrows, but this is generally not necessary, especially in highly endemic areas. Patients typically present with severe itch, linear burrows and papules around the finger webs, wrists, upper and lower limbs, and belt area. Infants and small children may have a more widespread rash, including involvement of the palms, soles of the feet, ankles, and sometimes the scalp. Inflammatory scabies nodules may be seen, particularly on the penis and scrotum of adult males and around the breasts of females. Because of the delay between initial infection and development of symptoms, scabies lesions may be seen in close contacts that have not yet developed itch.

• #1 Scabies Workup: Approach Considerations, Locating Mite Burrows, Skin Scraping

  https://emedicine.medscape.com/article/1109204-workup

  In routine scabies, a single mite is seen. Eosinophilic spongiosis may be present. […] Crusted scabies demonstrates massive hyperkeratosis of the stratum corneum, with innumerable mites in all stages of development. […] Nodular scabies reveals a dense, mixed, superficial and deep dermal inflammatory cell infiltrate.

• #1 Detection of scabies: A systematic review of diagnostic methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3222761/

  Skin scrapings are central to diagnosis and involve the application of one or two drops of mineral oil to a suspected lesion, which is then scraped or shaved with a scalpel or a microscope slide. […] A simple and often overlooked bedside test is the burrow ink test (BIT), in which fountain pen ink is gently rubbed on a suspicious site. […] Recently, in vivo mite identification by epiluminescence microscopy, using a dermatoscope, has been studied. […] The present review shows that the diagnosis of scabies infection is often imprecise or speculative. […] The literature on the diagnosis of scabies has significant limitations affecting both internal and external validity. […] Although the BIT has not been studied extensively, we believe that its minimal cost and adverse events, in addition to its rapid turnaround time, makes it a useful, but unproven diagnostic test. […] The present study confirms the lack of accurate and easily applicable methods for diagnosing scabies or for assessing the efficacy of treatment to eliminate mites. […] Hence, we include a practical algorithm to help diagnose scabies infection.

• #1 Scabies Workup: Approach Considerations, Locating Mite Burrows, Skin Scraping

  https://emedicine.medscape.com/article/1109204-workup

  Definitive testing relies on the identification of mites or their eggs, eggshell fragments, or scybala. This is best undertaken by placing a drop of mineral oil directly over the burrow on the skin and then superficially scraping longitudinally and laterally across the skin with a scalpel blade. […] The sample is placed on a microscope slide and examined under low and high power. Potassium hydroxide should not be used, since it can dissolve mite pellets. Failure to find mites is common and does not rule out the diagnosis of scabies. […] The histologic features of scabies are distinctive enough to suggest the diagnosis, although they are common to a variety of arthropod reactions. If a burrow is excised, mites, larvae, ova, and feces may be identified within the stratum corneum. […] A superficial and deep dermal infiltrate composed of lymphocytes, histiocytes, mast cells, and eosinophils is characteristic. Spongiosis and vesicle formation with exocytosis of eosinophils and occasional neutrophils are present.

• #1 Scabies – Wikipedia

  https://en.wikipedia.org/wiki/Scabies

  Scabies may be diagnosed clinically in geographical areas where it is common when diffuse itching presents along with either a lesion in two typical spots or itchiness is present in another household member. The classical sign of scabies is the burrow made by a mite within the skin. To detect the burrow, the suspected area is rubbed with ink from a fountain pen or a topical tetracycline solution, which glows under a special light. The skin is then wiped with an alcohol pad. If the person is infected with scabies, the characteristic zigzag or S pattern of the burrow will appear across the skin; however, interpreting this test may be difficult, as the burrows are scarce and may be obscured by scratch marks. A definitive diagnosis is made by finding either the scabies mites or their eggs and fecal pellets. Searches for these signs involve either scraping a suspected area, mounting the sample in potassium hydroxide and examining it under a microscope, or using dermoscopy to examine the skin directly. […] Symptoms of early scabies infestation mirror other skin diseases, including dermatitis, syphilis, erythema multiforme, various urticaria-related syndromes, allergic reactions, ringworm-related diseases, and other ectoparasites such as lice and fleas.

• #1 Diagnosis and treatment response monitoring of scabies with reflectance confocal microscopy: A diagnostic pearl – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/diagnosis-and-treatment-response-monitoring-of-scabies-with-reflectance-confocal-microscopy-a-diagnostic-pearl/

  Scabies is a common highly contagious skin parasitosis caused by the mite Sarcoptes scabiei var. hominis. Early identification and prompt treatment of infested subjects is essential, as missed diagnosis may result in outbreaks, considerable morbidity, and significantly increased economic burden. Diagnosis is based on the clinical picture and confirmation consists of the demonstration of the mite, its eggs, or feces (scybala) in skin scrapings. […] Dermoscopy is a simple and rapid technique that has demonstrated a high sensitivity (83%) in the diagnosis of scabies. […] RCM is a noninvasive imaging technique which allows real-time visualization of cellular components in the skin, providing serial transverse cuts at different depths. Mites, ova, and scybala can be observed in vivo and in real time using RCM, enabling the clinician to confirm the diagnosis of scabies without need to perform invasive techniques. According to some studies, RCM shows a specificity of 100% and a sensitivity of 92% for the diagnosis of scabies.

• #1 Scabies test

  https://dermnetnz.org/topics/scabies-test

  A high index of suspicion should be used when assessing a patient with a new widespread itchy rash, especially one who reports itchy close contacts. The diagnosis is typically clinical and most easily confirmed using dermoscopy. […] Several invasive and non-invasive tests exist to aid in confirming a diagnosis of scabies: Dermoscopy may reveal the delta wing jet or mini triangle sign. In crusted scabies, dermoscopy may show hyperkeratosis. Skin scrapings using either a blade or needle allow direct visualisation of mites eggs or mite faeces on microscopy. Visualisation of a live mite by the patient galvanises treatment concordance. Burrow ink test may reveal a classical zig zag line where ink has tracked into a burrow. Adhesive tape test is used to transfer a sample from a suspicious lesion directly to a microscope slide. Skin biopsy, although rarely necessary, will show eggs, larvae, faeces and mites.

• #1 Scabies Workup: Approach Considerations, Locating Mite Burrows, Skin Scraping

  https://emedicine.medscape.com/article/1109204-workup

  The diagnosis of scabies can often be made clinically in patients with a pruritic rash and characteristic linear burrows. The diagnosis is confirmed by light microscopic identification of mites, larvae, ova, or scybala (feces) in skin scrapings. […] In rare cases, mites are identified in biopsy specimens obtained to rule out other dermatoses. Characteristic histopathology in the absence of actual mites also may suggest the diagnosis of scabies. […] Clinically inapparent infection can be detected by amplification of Sarcoptes DNA in epidermal scale by polymerase chain reaction (PCR) assay. In addition, elevated IgE titers and eosinophilia may be demonstrated in some patients with scabies. […] A simple, cheap, sensitive, and specific test for routine diagnosis of active scabies is desirable. 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.

• #1 Scabies test

  https://dermnetnz.org/topics/scabies-test

  The International Alliance for the Control of Scabies (IACS) updated consensus criteria for the diagnosis of scabies in 2020, copied below: A: Confirmed scabies is diagnosed if there is at least one of: A1: Mites, eggs or faeces on light microscopy of skin samples A2: Mites, eggs or faeces visualized on an individual using a high-powered imaging device A3: Mite visualised on an individual using dermoscopy. B: Clinical scabies is diagnosed if there is at least one of: B1: Scabies burrows B2: Typical lesions affecting male genitalia B3: Typical lesions in a typical distribution and two history features. C: Suspected scabies is diagnosed if there is one of: C1: Typical lesions in a typical distribution and one history feature C2: Atypical lesions or atypical distribution and two history features. History features are: H1: Itch H2: Positive contact history with an individual who has an itch or typical lesions in a typical distribution.

• #1 Scabies Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/1109204-clinical

  Classic scabies typically has a distribution involving the axillae, elbow flexures, wrists and hands, and genital area. This is commonly known as the circle of Hebra. […] Signs and symptoms of pruritus tend to crescendo progressively over 2-3 weeks before compelling the patient to seek medical attention. […] If there is an outbreak in the community, consider scabies in an individual presenting with rash and itching. […] Patients who have had scabies misdiagnosed may have been treated with topical corticosteroids. This delays the correct diagnosis as the lesions may take on the incognito form in which lesions might appear as vesicles, pustules, or nodules and whose distribution could become diffuse. […] Characteristic findings include excoriations, widespread eczema, honey-colored crusting, postinflammatory hyperpigmentation, erythroderma, prurigo nodules, and frank pyoderma.

• #1 Epidemiology, Diagnosis, and Treatment of Scabies in a Dermatology Office | American Board of Family Medicine

  https://www.jabfm.org/content/30/1/78

  Scabies can be difficult to diagnose for even the most experienced physicians, as examination findings can be subtle and patients may not relate key historic clues of severe pruritus that is worse at night, close contacts who have similar symptoms, and a history of exposure. […] A gold standard diagnosis relies on the visualization of ova, feces, or the mites themselves using light microscopy. […] Health care providers used several different methods to diagnose scabies in this study, and 58% of the diagnoses were made by seeing the mite or its ova or feces upon microscopic examination of a skin scraping. […] Of the patients diagnosed with scabies, 45% had been misdiagnosed by another health care provider. […] The frequency of misdiagnosis of scabies supports the need for a more definitive diagnosis option.

• #1 Scabies – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544306/

  Not all individuals exhibit classic manifestations of scabies infestations, which can make the infection challenging to diagnose. […] Pruritis among several family members or close contacts should always cause the provider to think of scabies. […] Treatment failure is common, and isolating the cause can help prevent further infection and limit outbreaks in communities. […] Reasons for treatment failure include not treating close contacts simultaneously, not decontaminating beddings and clothes at the time of treatment, and nonadherence to the treatment regimen. […] Recognizing scabies infection and being able to diagnose this condition is crucial for patient care. […] Education about scabies and its presentations is essential for all providers coordinating care, including primary care, emergency medicine, urgent care, pharmacy and even dermatology.

• #1

  https://journals.lww.com/md-journal/fulltext/2023/05260/the_currently_available_diagnostic_tools_and.29.aspx

  The diagnosis of scabies is confirmed through microscopic examination of mites, eggs, or feces from obtained scales by skin scraping. […] Scabies diagnosis based on histopathology is considered to be one of the most accurate tests. […] There are no available standardized laboratory tests for diagnosing scabies. […] The enzyme-linked immunosorbent assay (ELISA) detects the antibodies of S scabiei, which are produced prior to the onset of clinical symptoms. […] Nested-PCR based on the C-oxidase subunit (cox1) gene of S scabiei is considered a highly sensitive test for scabies diagnosis. […] The diagnosis of treatment failure should not be made until at least 6 weeks after treatment has been completed, because it can take this long for signs and symptoms of hypersensitivity to resolve. […] The early diagnosis and treatment of scabies are important to prevent complications and reduce transmission.

• #1

  https://bpac.org.nz/2022/scabies.aspx

  If crusted scabies is suspected, a diagnosis should always be confirmed by dermatoscopy (preferably digital) or from skin scrapings. […] Laboratory-based microscopy of burrow content and skin scrapings can be used to identify mites, their eggs or faeces to confirm scabies in patients where the diagnosis is uncertain or in atypical cases, e.g. a major outbreak in a residential care facility. A negative result does not always exclude scabies due to the possibility of sampling error.

• #1 Scabies: diagnosis and treatment | The BMJ

  https://www.bmj.com/content/331/7517/619

  A history of itching in several family members over the same period is almost pathognomonic. […] However, lack of a history of itching in family members does not exclude scabies. […] It is important to remember that recurrence of symptoms after attempted treatment does not exclude the diagnosis of scabies because patients may not have treated themselves correctly or may have been reinfested by an untreated contact. […] A high index of suspicion is needed to diagnose scabies correctly. […] Consider scabies in any adult with widespread eczema.

• #2 Scabies – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544306/

  Scabies is transmitted by direct skin-to-skin contact or indirectly by contact with contaminated material (fomites). […] This condition is often challenging to diagnose as many patients may have only subtle symptoms. […] However, other patients may present with the classic history of exposure, severe pruritis that is worse at night, and reference to other individuals with similar symptoms. […] Scabies is classically diagnosed by visualization of the rash as well as patient history. […] Scabies can be diagnosed by visualizing mites in skin scrapings in the stratum corneum. […] This method often misses the correct diagnosis because of the high chance of sampling error. […] If the diagnosis is ambiguous, a skin biopsy can be used to confirm the diagnosis. […] In addition to biopsy, a newly developed serologic test can aid in the diagnosis of scabies.

• #2 Scabies Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/1109204-clinical

  Patient history can reliably suggest the presence of scabies. Lesion distribution and intractable pruritus that is worse at night, as well as scabies symptoms in close contacts (including multiple family members), should immediately rank scabies at the top of the clinical differential diagnosis. […] Clinical findings include primary and secondary lesions. Primary lesions are the first manifestation of the infestation and typically include small papules, vesicles, and burrows. Secondary lesions are the result of rubbing and scratching, and they may be the only clinical manifestation of the disease. If so, the diagnosis must be inferred by the history, lesion distribution, and accompanying symptoms. […] Burrows are a pathognomonic sign and represent the intraepidermal tunnel created by the moving female mite. They appear as serpiginous, grayish, threadlike elevations in the superficial epidermis, ranging from 2-10 mm long.

• #2 Scabies

  https://www.nhs.uk/conditions/scabies/

  Scabies is an itchy rash caused by mites. It’s spread through close skin contact, and anyone can get it. It should be treated quickly to stop it spreading. […] The symptoms of scabies are: intense itching, especially at night; a raised rash or spots. […] The scabies rash usually spreads across the whole body, apart from the head and neck. It often affects skin between the fingers, around the wrists, under the arms, and around the waist, groin and bottom. […] People with a weakened immune system can sometimes get a rare and very contagious type of scabies called crusted scabies. The main symptom is a crusted, flaky rash that often affects the elbows, knees, hands and feet. […] Scabies is not usually a serious condition, but it does need to be treated. […] Scabies is very infectious, but it can take up to 8 weeks for the rash to appear.

• #2 Scabies Workup: Approach Considerations, Locating Mite Burrows, Skin Scraping

  https://emedicine.medscape.com/article/1109204-workup

  The diagnosis of scabies can often be made clinically in patients with a pruritic rash and characteristic linear burrows. The diagnosis is confirmed by light microscopic identification of mites, larvae, ova, or scybala (feces) in skin scrapings. […] In rare cases, mites are identified in biopsy specimens obtained to rule out other dermatoses. Characteristic histopathology in the absence of actual mites also may suggest the diagnosis of scabies. […] Clinically inapparent infection can be detected by amplification of Sarcoptes DNA in epidermal scale by polymerase chain reaction (PCR) assay. In addition, elevated IgE titers and eosinophilia may be demonstrated in some patients with scabies. […] A simple, cheap, sensitive, and specific test for routine diagnosis of active scabies is desirable. 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.

• #2 Scabies Workup: Approach Considerations, Locating Mite Burrows, Skin Scraping

  https://emedicine.medscape.com/article/1109204-workup

  Definitive testing relies on the identification of mites or their eggs, eggshell fragments, or scybala. This is best undertaken by placing a drop of mineral oil directly over the burrow on the skin and then superficially scraping longitudinally and laterally across the skin with a scalpel blade. […] The sample is placed on a microscope slide and examined under low and high power. Potassium hydroxide should not be used, since it can dissolve mite pellets. Failure to find mites is common and does not rule out the diagnosis of scabies. […] The histologic features of scabies are distinctive enough to suggest the diagnosis, although they are common to a variety of arthropod reactions. If a burrow is excised, mites, larvae, ova, and feces may be identified within the stratum corneum. […] A superficial and deep dermal infiltrate composed of lymphocytes, histiocytes, mast cells, and eosinophils is characteristic. Spongiosis and vesicle formation with exocytosis of eosinophils and occasional neutrophils are present.

• #2 Scabies: Symptoms, Causes, Diagnosis and Treatment

  https://www.metropolisindia.com/blog/preventive-healthcare/everything-you-need-to-know-about-scabies

  Most scabies cases can be determined by closely monitoring your skin if there is a rash. To confirm this disease, your healthcare provider will most probably apply a mineral oil to the rash and take a tiny sample of the skin by scraping it. The sample will then be placed under a microscope to examine the mite eggs or mites. […] You can apply a cream that contains permethrin for scabies treatment. The cream will be used on the complete body below your head. It will include hands, feet, soles, and palms. If your child has scabies, then your healthcare provider may apply the cream to the scalp. Permethrin cream is then left on the skin for around 14 hours. Usually, the cream is applied at night and washed off in the morning. […] Through proper treatment, you can reduce scabies symptoms like itching and rash and finally treat the infection. For the first few days of the week, your rashes and itch can worsen during treatment. After 4 weeks, your skin will start healing. If the skin hasn’t healed within 4 weeks, it implies you still have mites in your body. In such a condition, you need to contact your healthcare provider to repeat the medicine doses until the infection is completely cured.

• #2 About Scabies | Scabies | CDC

  https://www.cdc.gov/scabies/about/index.html

  Your healthcare professional can sometimes diagnose scabies based on physical exam findings and history but will likely try to confirm scabies by finding the mite, mite eggs, or feces (scybala). […] A person can still have scabies even if mites, eggs, or feces are not found. Fewer than 10 15 mites may be present on an infected person who is otherwise healthy.

• #2 Additional Techniques for Diagnosing Scabies | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0415/p536.html

  TO THE EDITOR: This article did not mention a valuable technique to assist in the diagnosis of scabies: the ink burrow test. When ink is applied over suspect skin areas, it is absorbed where mite burrows exist under the skin. Wiping away superficial ink reveals remaining ink that has penetrated the burrows. […] Also, microscopic identification of mites, eggs, and fecal pellets can be performed by suspending skin scrapings in mineral oil. Mites will adhere to the oil, and skin scales will mix with the oil. Refractility differences will be greater between the mite and the oil. The oil will not dissolve fecal pellets. […] We agree that mineral oil is superior to KOH preparations for the microscopic examination of skin scrapings in the diagnosis of scabies, and included recommendations to use mineral oil when testing is indicated.

• #2 Scabies – treatments, symptoms and causes | healthdirect

  https://www.healthdirect.gov.au/scabies

  Scabies is very contagious and spreads quickly. […] How is scabies diagnosed? […] Your doctor will examine your skin. They will also ask you about your symptoms and whether anyone you live with has itchy skin. […] Your doctor may put ink from a pen over a burrow entrance. If the ink moves along the burrow, this confirms scabies. […] The doctor may also take a small scraping from your skin to confirm the diagnosis.

• #2 Detection of scabies: A systematic review of diagnostic methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3222761/

  Skin scrapings are central to diagnosis and involve the application of one or two drops of mineral oil to a suspected lesion, which is then scraped or shaved with a scalpel or a microscope slide. […] A simple and often overlooked bedside test is the burrow ink test (BIT), in which fountain pen ink is gently rubbed on a suspicious site. […] Recently, in vivo mite identification by epiluminescence microscopy, using a dermatoscope, has been studied. […] The present review shows that the diagnosis of scabies infection is often imprecise or speculative. […] The literature on the diagnosis of scabies has significant limitations affecting both internal and external validity. […] Although the BIT has not been studied extensively, we believe that its minimal cost and adverse events, in addition to its rapid turnaround time, makes it a useful, but unproven diagnostic test. […] The present study confirms the lack of accurate and easily applicable methods for diagnosing scabies or for assessing the efficacy of treatment to eliminate mites. […] Hence, we include a practical algorithm to help diagnose scabies infection.

• #2 Epidemiology, Diagnosis, and Treatment of Scabies in a Dermatology Office | American Board of Family Medicine

  https://www.jabfm.org/content/30/1/78

  The use of dermoscopy to diagnose scabies can decrease the false-negative diagnosis rate when compared with skin scrapings. […] Our findings suggest that more accurate and faster diagnostic methods are needed to diagnose scabies in order to limit unnecessary treatment and expedite appropriate therapy.

• #2 Scabies: A clinical update

  https://www.racgp.org.au/afp/2017/may/scabies-a-clinical-update

  Clinical examination remains the mainstay of diagnosis, although dermatoscopy is a useful adjunct. […] Diagnosis is usually made on the basis of clinical features alone. Multiple household members with itch should raise suspicion of scabies. […] Applying ink from a pen over a burrow entrance can confirm its presence as ink tracks along the burrow. Dermatoscopy can be used to identify the characteristic delta sign, representing the mites mouth parts, and the jet with contrail pattern representing a mite and its burrow. […] Definitive diagnosis can be made by taking a skin scraping for analysis under light microscopy. The finding of the mite, its eggs or faecal pellets are diagnostic for scabies. […] Diagnosis of crusted scabies requires confirmation by skin scrapings because of the intensity of treatment and public health implications. The extensive scale and high burden of mites makes specimen collection easier, and identification with magnification more sensitive.

• #2 Diagnosis and treatment response monitoring of scabies with reflectance confocal microscopy: A diagnostic pearl – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/diagnosis-and-treatment-response-monitoring-of-scabies-with-reflectance-confocal-microscopy-a-diagnostic-pearl/

  In conclusion, if an RCM device is available, it may be utilized as a noninvasive tool for the diagnosis of scabies. After performing a clinical and a dermoscopic examination of the skin, performance of RCM on the suspected areas is useful to confirm the presence of the parasites and to establish their viability after treatment.

• #2 Slowly Spreading Scabies With a Diagnosis Confirmed by Confocal Reflectance Microscopy: New Technologies for Diagnosis | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/en-slowly-spreading-scabies-with-diagnosis-articulo-S1578219021000056

  RCM is a novel diagnostic technique in dermatology that enables the diagnosis of tumors and inflammatory and infectious diseases with high sensitivity and specificity. […] RCM allows easy visualization of other parasites, including Demodex folliculorum, as well as various mycoses. […] A range of imaging tools that facilitate the diagnosis of scabies have recently emerged. RCM is a rapid, painless, highly sensitive and specific additional technique that can help establish diagnosis in atypical or doubtful cases of scabies.

• #2 Challenges in Public Health: The Diagnosis and Treatment of Crusted Scabies | SKIN The Journal of Cutaneous Medicine

  https://skin.dermsquared.com/skin/article/view/3269

  Crusted scabies is characterized clinically by hyperkeratotic papules and plaques, most commonly on the palms and soles. Due to the variety of presentations seen in scabies, it can be difficult to diagnose. […] The patients were diagnosed with skin scrapings or biopsy showing scabies mites. […] Management of crusted scabies is different than for other types of scabies because the patient is infested with large numbers of mites. […] Treatment of crusted scabies requires a combination of oral and topical treatments. […] The large number of mites in crusted scabies requires more rigorous evaluation and treatment of contacts than other types of scabies.

• #2

  https://journals.lww.com/md-journal/fulltext/2023/05260/the_currently_available_diagnostic_tools_and.29.aspx

  The diagnosis of scabies is confirmed through microscopic examination of mites, eggs, or feces from obtained scales by skin scraping. […] Scabies diagnosis based on histopathology is considered to be one of the most accurate tests. […] There are no available standardized laboratory tests for diagnosing scabies. […] The enzyme-linked immunosorbent assay (ELISA) detects the antibodies of S scabiei, which are produced prior to the onset of clinical symptoms. […] Nested-PCR based on the C-oxidase subunit (cox1) gene of S scabiei is considered a highly sensitive test for scabies diagnosis. […] The diagnosis of treatment failure should not be made until at least 6 weeks after treatment has been completed, because it can take this long for signs and symptoms of hypersensitivity to resolve. […] The early diagnosis and treatment of scabies are important to prevent complications and reduce transmission.

• #2 Clinical practice guidelines for the diagnosis and treatment of scabies in Korea: Part 1. Epidemiology, clinical manifestations, and diagnosis — a secondary publication

  https://www.e-emj.org/journal/view.php?number=10

  The diagnosis of scabies primarily relies on a clinical evaluation, which includes assessing contact history and identifying characteristic skin lesions. Confirmation is achieved through microscopy, dermoscopy, or high-magnification imaging techniques that detect mites. […] Recently, a consensus was reached by 34 global scabies experts on standardized diagnostic criteria for scabies. These criteria categorize the diagnosis into three levels based on diagnostic certainty: suspected, clinical, and confirmed. This stratification provides a valuable tool for diagnosing classic scabies in various clinical settings. […] Contact history is a crucial factor in diagnosing scabies, as it is observed in most cases. When a patient presents with pruritic skin lesions and has a history of contact with someone diagnosed with scabies, scabies should be suspected.

• #2 Scabies: A Case of Misdiagnosed Severe Itching – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/home/general-infectious-disease/scabies-case-study-misdiagnosed-severe-itching-2/2/

  Scrapings can be examined immediately after collection, often quickly finding scabietic elements. […] Before treatment, clinicians must rule out other conditions as part of the differential diagnosis, including eczema, xerosis, and contact/irritant dermatitis, among many other conditions. […] A dermatoscope with 10 magnification can also be used to diagnose scabies. […] As this case illustrates, the presentation of scabies varies significantly from case to case. […] The itchy penile papules were also highly suggestive of scabies and were all but pathognomonic for that diagnosis, even when found on other family members. […] The lack of microscopic confirmation lead to much confusion and needless suffering for this patient and his family.

• #2 Scabies – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/scabies/

  Diagnosis is typically clinical. […] Detection of mites, larvae, ova, or mite feces on any of the following: Dermoscopy, Microscopic examination of the skin, Skin scraping and histology (low sensitivity). […] Scabies may be mistaken for eczema, especially as the topical use of glucocorticoids initially alleviates symptoms.

• #2 Epidemiology, Diagnosis, and Treatment of Scabies in a Dermatology Office | American Board of Family Medicine

  https://www.jabfm.org/content/30/1/78

  Scabies can be difficult to diagnose for even the most experienced physicians, as examination findings can be subtle and patients may not relate key historic clues of severe pruritus that is worse at night, close contacts who have similar symptoms, and a history of exposure. […] A gold standard diagnosis relies on the visualization of ova, feces, or the mites themselves using light microscopy. […] Health care providers used several different methods to diagnose scabies in this study, and 58% of the diagnoses were made by seeing the mite or its ova or feces upon microscopic examination of a skin scraping. […] Of the patients diagnosed with scabies, 45% had been misdiagnosed by another health care provider. […] The frequency of misdiagnosis of scabies supports the need for a more definitive diagnosis option.

• #2 Comparison of Skin Scraping and Standard Superficial Skin Biopsy in the Laboratory Diagnosis of Scabies – Turkish Journal of Parasitology

  https://turkiyeparazitolderg.org/articles/comparison-of-skin-scraping-and-standard-superficial-skin-biopsy-in-the-laboratory-diagnosis-of-scabies/doi/tpd.galenos.2020.6828

  In this study, it was aimed to compare the analytical performance of two distinct sampling methods retrospectively in which cases burrows were shown via dermatoscopy and to investigate the correlation with false negativity problem in the laboratory diagnosis of scabies. […] The sensitivity value calculated for the microscopic examination of the samples taken by the skin scraping method for laboratory diagnosis of scabies in the presented study is similar to the sensitivity values reported in the literature. […] In our study, SSSB method has been shown to have significantly higher sensitivity than skin scraping method for laboratory diagnosis of scabies. […] Because of the above-mentioned issues about the diagnosis, a negative result obtained by any diagnostic method cannot exclude scabies, even for an experienced specialist.

• #2 Epidemiology, Diagnosis, and Treatment of Scabies in a Dermatology Office | American Board of Family Medicine

  https://www.jabfm.org/content/30/1/78.short

  Background: Scabies is a neglected skin disease, and little is known about current incidence and treatment patterns in the United States. […] The majority of diagnoses were made by visualizing ova, feces, or mites on light microscopy (58%). […] At the time of diagnosis, 45% of patients had been misdiagnosed by another provider. […] Our findings suggest that more accurate and faster diagnostic methods are needed to limit unnecessary treatment and expedite appropriate therapy for scabies.

• #2 Scabies: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4567-scabies

  No, scabies won’t go away on its own. Only prescription medication can treat it. If you don’t treat it, you’ll probably continue to spread the disease to other people. […] Scabies is treatable but can be hard to get rid of completely. Certain forms of scabies are harder to treat, such as the crusted form. […] Talk to your healthcare provider if you don’t see your symptoms improve with medication or if you still have a rash after four weeks. You may need repeat treatment to get rid of any remaining mites.

• #2 Scabies: Symptoms, Causes, Diagnosis and Treatment

  https://www.metropolisindia.com/blog/preventive-healthcare/everything-you-need-to-know-about-scabies

  If you have a scabies rash, you must contact your healthcare provider to get rid of it as soon as possible. Early scabies treatment will avoid its further spreading. […] Scabies causes are treatable but may take time to go away. Certain types of scabies, like crusted form, are hard to treat. Also, you may require more than one round of treatment to ensure that the infection is completely cured.

• #2 Scabies: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/scabies-treatment

  Treatment can get rid of the mites, eliminate symptoms such as itch, and treat an infection that has developed. […] If your skin has not healed within 4 weeks, you may still have mites. Some people need to treat two or three times to get rid of the mites. […] People who develop crusted scabies, also known as Norwegian scabies, often need repeat treatments to get rid of the mites. […] To get rid of the mites and prevent getting scabies again, you have to do more than treat the skin or take a pill. You will need to wash clothes, bedding, and towels to get rid of mites that may have fallen off your skin. You also should vacuum your entire home.

• #2 Scabies: Advances in Noninvasive Diagnosis | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004691

  The standard technique for the diagnosis of scabies consists of the identification of the mite, eggs, or feces by microscopic examination of scales obtained by skin scraping. […] Other diagnostic procedures include the burrow ink test, the adhesive tape test, and the polymerase chain reaction (PCR)-based method for detecting S. scabiei DNA in skin scrapings. […] In recent years, some advanced and noninvasive techniques such as videodermatoscopy, dermatoscopy, in vivo reflectance confocal microscopy, and optical coherence tomography have demonstrated improved efficacy in the diagnosis of scabies. […] The advantages of using the specialized devices described in this review include rapid noninvasive mass-screening, post-therapeutic follow-up, and, in addition to no physical risk, minimization of complications associated with a missed scabies diagnosis. […] Although these techniques are fairly well-known among dermatologists, a greater knowledge among general practitioners and other specialists involved in the care of overcrowded populations vulnerable to scabies infestations is now viewed as urgent and important in the management of outbreaks.

• #2 The diagnosis of scabies by non-expert examiners: A study of diagnostic accuracy | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007635

  The diagnosis of scabies by non-expert examiners: A study of diagnostic accuracy […] Although scabies is estimated to be one of the most common skin conditions globally, prevalence data is not available in most settings. […] Four non-expert health workers were trained in the diagnosis of scabies and impetigo. […] The sensitivity of the non-expert health workers diagnosis compared to the reference standard was 55.3% for scabies (95% confidence interval [CI], 50.160.4) with a specificity of 89.9% (95% CI 8693.1) and 52.6% for impetigo (95% CI 46.958.3) with a specificity 97.8% (95% CI 95.799). […] Following brief training, the diagnostic accuracy of non-expert health workers for scabies and impetigo was promising, especially for moderate to severe disease. […] The diagnosis of scabies in low resource settings, where the disease is most prevalent, is reliant on clinical examination. […] A task shifting approach, utilizing local health staff, could substantially increase the feasibility to undertake mapping surveys in low-resource settings. […] Our study found that these non-expert health workers could diagnose scabies with moderate accuracy and diagnose more severe disease with high accuracy. […] The clinical assessment of trained, non-expert examiners has been used for diagnosis and mapping for other NTDs including trachoma, leprosy and podoconiosis. […] The index test was the clinical diagnosis of scabies (and impetigo) by non-expert examiners (the four nurses) following training. […] The reference standard was the diagnosis made by two medical doctors (a dermatologist and a pediatrician) with extensive experience in the diagnosis of scabies and tropical skin diseases. […] The sensitivity of the index test compared to the reference standard for scabies diagnosis was 55.3% (95% CI 50.160.4). […] When considering only the moderate and severe cases of scabies (n = 31), the sensitivity of the index test was 93.5% (95% CI 86.397.6). […] We found that briefly trained, non-expert examiners had moderate sensitivity and high specificity in the diagnosis of scabies using the IACS Criteria, compared to reference diagnosis by two expert examiners. […] Our results suggest that modifications to the training protocol are needed to maximize the accuracy and utility for non-expert scabies assessment. […] This study was the first to implement the IACS Criteria for scabies diagnosis. […] In order for scabies prevalence mapping to occur, either in isolation, or integrated with other NTD assessments, governments and organizations need to be able to feasibly and confidently train local staff in diagnosis.

• #2

  https://journals.lww.com/md-journal/fulltext/2023/05260/the_currently_available_diagnostic_tools_and.29.aspx

  Scabies is a neglected tropical disease that continues to have global impacts and long-term health consequences. […] The diagnosis of scabies may be assisted by invasive and noninvasive tools; However, the history and examination findings are usually adequate to confirm the clinical suspicion. […] The diagnosis of scabies is usually established clinically and based on patient history. […] To assist physicians in the diagnosis of scabies, the 2020 International Alliance for the Control of Scabies consensus criteria as a standardized tool. […] These criteria present 3 categories of diagnosis: Confirmed scabies, clinical scabies, or suspected scabies. […] Some noninvasive diagnostic techniques such as dermatoscopy, videodermatoscopy, in vivo reflectance confocal microscopy (RCM), and optical coherence tomography (OCT) can help to confirm the diagnosis of scabies.

• #3 Scabies Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/1109204-clinical

  Patient history can reliably suggest the presence of scabies. Lesion distribution and intractable pruritus that is worse at night, as well as scabies symptoms in close contacts (including multiple family members), should immediately rank scabies at the top of the clinical differential diagnosis. […] Clinical findings include primary and secondary lesions. Primary lesions are the first manifestation of the infestation and typically include small papules, vesicles, and burrows. Secondary lesions are the result of rubbing and scratching, and they may be the only clinical manifestation of the disease. If so, the diagnosis must be inferred by the history, lesion distribution, and accompanying symptoms. […] Burrows are a pathognomonic sign and represent the intraepidermal tunnel created by the moving female mite. They appear as serpiginous, grayish, threadlike elevations in the superficial epidermis, ranging from 2-10 mm long.

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