Scabies in Infants: Diagnosis and Safe Treatment

Overview / Definition Scabies is a contagious skin infestation caused by the Sarcoptes scabiei mite, which burrows into the epidermis and leads to intense pruritus and inflammation. In infants and young children, scabies can present differently than in adults, often leading to misdiagnosis if not recognized early. Epidemiology Scabies affects individuals of all ages, but infants and young children are particularly susceptible due to their close contact with caregivers and others. Prevalence rates can be higher in crowded living conditions, such as childcare centers or shelters. Outbreaks are more common in warmer climates and during certain seasons. Pathophysiology / Mechanism The Sarcoptes scabiei mite is a parasitic arthropod that burrows into the stratum corneum of the skin, leading to a hypersensitivity reaction to mite antigens. This results in: Inflammation and pruritus due to immune response. Secondary bacterial infections can occur due to scratching. Clinical Presentation In infants, scabies may present with: Intense itching, particularly at night. Rash characterized by papules, pustules, and crusted lesions, often seen on: Hands and feet Face and scalp Intertriginous areas Possible secondary infections manifested as erythema, oozing, or crusting. Diagnosis / Workup The diagnosis of scabies is primarily clinical, supported by: History of pruritus, especially at night. Identification of typical lesions and distribution. Microscopic examination of skin scrapings may reveal mites or eggs. Consider differential diagnoses such as: Atopic dermatitis Contact dermatitis Impetigo Tinea infections Treatment / Management The management of scabies in infants involves: Topical scabicides: Permethrin 5% cream: safe for infants, applied from the neck down and left on for 8-14 hours. Benzyl benzoate: less commonly used due to irritation potential. Malathion: used in cases of resistance but caution is needed due to flammability. Oral ivermectin: considered in cases of severe