Analysis of clinical features of 78 infants with scabies / 中华皮肤科杂志

ABSTRACT

Objective:To analyze clinical features of 78 infants with scabies and their causes of misdiagnosis.Methods:A retrospective analysis was performed on infants aged < 6 months with confirmed scabies at Department of Dermatology in Zhengzhou Children′s Hospital, Jingjiang People′s Hospital, Tangdu Hospital of the Fourth Military Medical University, Second Affiliated Hospital of Soochow University and Henan Provincial People′s Hospital from January 1, 2016 to December 31, 2018. Then, epidemiological features, skin lesion characteristics, treatment and causes of misdiagnosis of infantile scabies were analyzed.Results:A total of 78 infants with scabies were collected. Their age of onset and duration from onset to diagnosis [ M ( P25, P75) ] were 8.5 (7, 12) and 4 (3.5, 5) weeks respectively. At the time of diagnosis, 45 (57.7%) patients showed lower body weight than the first quartile [ P25] of body weight of age- and gender-matched healthy peers, 40 (47.4%) had fussiness and irritation, and 68 (87.2%) had sleep disorders like night crying and increased frequency of night waking. Infantile scabies more frequently occurred in autumn (30 cases [38.5%]) and winter (22 cases [28.2%]) , and least frequently occurred in summer (8 cases [10.3%]) . In the case of 58 patients, there was at least 1 member with scabies at the same time, who had resided with the patients in their families for a long time; in the case of 12 patients, scabies was transmitted through previous contact with temporary residents with scabies in their families. Scabies lesions most commonly occurred on the chest and abdominal regions (80.8%) , followed by the limbs (76.9%) ; skin lesions were polymorphic, and lesions at different stages could coexist; the rashes mainly manifested as edematous red or non-edematous brown papules, blisters, papulovesicles and nodules, and some burrows could be characterized by an oval, linear, serpiginous, comma- or J-shaped appearance. All the patients had visited the clinic for 1 - 4 times with an average of 2.38 visits. Forty-eight (61.5%) patients initially visited non-dermatology departments, and 30 (38.5%) initially visited dermatological outpatient clinics. Incorrect diagnoses included infantile eczema, papular urticaria, impetigo, miliaria, prurigo, urticaria pigmentosa, infantile acropustulosis, herpes simplex and varicella. All the patients received topical sulfur 5% ointment. Nine (11.5%) patients experienced a sudden exacerbation of skin lesions after the topical treatment, and 20 (25.6%) needed 2 - 3 sessions of treatment. No recurrence was observed in all the patients at 2, 4 and 8 weeks after the end of treatment. Conclusions:Infantile scabies lesions are polymorphic, widely distributed, and easily misdiagnosed. To prevent misdiagnosis and improve the early diagnosis rate, a detailed clinical interrogation with clinical-epidemiological examination should be performed.