Thompson Russell, Westbury Sean, Slape Dana
Faculty of Medicine, UNSW, Kensington Campus, Sydney, NSW, Australia.
Prince of Wales Hospital, Randwick, Sydney, NSW, 2031, Australia.
Drugs Context. 2021 Mar 26;10. doi: 10.7573/dic.2020-12-3. eCollection 2021.
This narrative review addresses scabies, a highly contagious, pruritic infestation of the skin caused by the mite S. Scabies is a common disorder that has a prevalence worldwide estimated to be between 200 and 300 million cases per year. Infestation is of greatest concern in children, the elderly, immunocompromised people and resource-poor endemic populations at risk of chronic complications. A diagnosis of scabies involves a clinical suspicion, a detailed targeted history, clinical examination and contact tracing. Dermoscopy and microscopy, where available, is confirmatory. Due to its infectivity and transmissibility, the management for scabies requires a multimodal approach: topical antiscabetic agents are the first line for most cases of childhood classic scabies and their contacts, which must also be identified and treated to prevent treatment failure and reacquisition. Environmental strategies to control fomite-related reinfestation are also recommended. Oral ivermectin, where available, is reserved for use in high-risk cases in children or in mass drug administration programmes in endemic communities. The prevention of downstream complications of scabies includes surveillance, early identification and prompt treatment for secondary bacterial infections, often superficial but can be serious and invasive with associated chronic morbidity and mortality. Post-scabetic itch and psychosocial stigma are typical sequelae of the scabies mite infestation. The early identification of patients with scabies and treatment of their contacts reduces community transmission. Although time consuming and labour intensive for caregivers, the implementation of appropriate treatment strategies usually results in prompt cure for the child and their contacts. Here, we provide a summary of treatments and recommendations for the management of paediatric scabies.
本叙述性综述探讨疥疮，这是一种由疥螨引起的具有高度传染性、瘙痒性的皮肤感染。疥疮是一种常见疾病，全球患病率估计每年在2亿至3亿例之间。感染在儿童、老年人、免疫功能低下者以及有慢性并发症风险的资源匮乏流行地区人群中最为令人担忧。疥疮的诊断包括临床怀疑、详细的针对性病史、临床检查和接触者追踪。如有条件，皮肤镜检查和显微镜检查可作为确诊依据。由于其传染性和传播性，疥疮的管理需要采取多模式方法：局部抗疥疮药物是大多数儿童经典疥疮病例及其接触者的一线治疗药物，必须识别并治疗接触者以防止治疗失败和再次感染。还建议采取环境策略来控制与污染物相关的再感染。如有条件，口服伊维菌素保留用于儿童高危病例或流行社区的大规模药物给药计划。疥疮下游并发症的预防包括监测、早期识别和及时治疗继发性细菌感染，这些感染通常表浅，但可能严重且具有侵袭性，并伴有相关的慢性发病率和死亡率。疥疮后瘙痒和社会心理耻辱感是疥螨感染的典型后遗症。早期识别疥疮患者并治疗其接触者可减少社区传播。尽管对护理人员来说既耗时又费力，但实施适当的治疗策略通常能使儿童及其接触者迅速治愈。在此，我们总结了小儿疥疮治疗方法和管理建议。
