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A novel clinical grading scale to guide the management of crusted scabies.
PLoS Negl Trop Dis. 2013; 7(9):e2387.PN

Abstract

BACKGROUND

Crusted scabies, or hyperinfestation with Sarcoptes scabiei, occurs in people with an inadequate immune response to the mite. In recent decades, data have emerged suggesting that treatment of crusted scabies with oral ivermectin combined with topical agents leads to lower mortality, but there are no generally accepted tools for describing disease severity. Here, we describe a clinical grading scale for crusted scabies and its utility in real world practice.

METHODOLOGY/PRINCIPAL FINDINGS

In 2002, Royal Darwin Hospital (RDH), a hospital in tropical Australia developed and began using a clinical grading scale to guide the treatment of crusted scabies. We conducted a retrospective observational study including all episodes of admission to RDH for crusted scabies during the period October 2002-December 2010 inclusive. Patients who were managed according to the grading scale were compared with those in whom the scale was not used at the time of admission but was calculated retrospectively. There were 49 admissions in 30 patients during the study period, of which 49 (100%) were in Indigenous Australians, 29 (59%) were male and the median age was 44.1 years. According to the grading scale, 8 (16%) episodes were mild, 24 (49%) were moderate, and 17 (35%) were severe. Readmission within the study period was significantly more likely with increasing disease severity, with an odds ratio (95% CI) of 12.8 (1.3-130) for severe disease compared with mild. The patients managed according to the grading scale (29 episodes) did not differ from those who were not (20 episodes), but they received fewer doses of ivermectin and had a shorter length of stay (11 vs. 16 days, p = 0.02). Despite this the outcomes were no different, with no deaths in either group and a similar readmission rate.

CONCLUSIONS/SIGNIFICANCE

Our grading scale is a useful tool for the assessment and management of crusted scabies.

Authors+Show Affiliations

Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia ; Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24069468

Citation

Davis, Joshua S., et al. "A Novel Clinical Grading Scale to Guide the Management of Crusted Scabies." PLoS Neglected Tropical Diseases, vol. 7, no. 9, 2013, pp. e2387.
Davis JS, McGloughlin S, Tong SY, et al. A novel clinical grading scale to guide the management of crusted scabies. PLoS Negl Trop Dis. 2013;7(9):e2387.
Davis, J. S., McGloughlin, S., Tong, S. Y., Walton, S. F., & Currie, B. J. (2013). A novel clinical grading scale to guide the management of crusted scabies. PLoS Neglected Tropical Diseases, 7(9), e2387. https://doi.org/10.1371/journal.pntd.0002387
Davis JS, et al. A Novel Clinical Grading Scale to Guide the Management of Crusted Scabies. PLoS Negl Trop Dis. 2013;7(9):e2387. PubMed PMID: 24069468.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A novel clinical grading scale to guide the management of crusted scabies. AU - Davis,Joshua S, AU - McGloughlin,Steven, AU - Tong,Steven Y C, AU - Walton,Shelley F, AU - Currie,Bart J, Y1 - 2013/09/12/ PY - 2013/06/14/received PY - 2013/07/16/accepted PY - 2013/9/27/entrez PY - 2013/9/27/pubmed PY - 2014/3/13/medline SP - e2387 EP - e2387 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 7 IS - 9 N2 - BACKGROUND: Crusted scabies, or hyperinfestation with Sarcoptes scabiei, occurs in people with an inadequate immune response to the mite. In recent decades, data have emerged suggesting that treatment of crusted scabies with oral ivermectin combined with topical agents leads to lower mortality, but there are no generally accepted tools for describing disease severity. Here, we describe a clinical grading scale for crusted scabies and its utility in real world practice. METHODOLOGY/PRINCIPAL FINDINGS: In 2002, Royal Darwin Hospital (RDH), a hospital in tropical Australia developed and began using a clinical grading scale to guide the treatment of crusted scabies. We conducted a retrospective observational study including all episodes of admission to RDH for crusted scabies during the period October 2002-December 2010 inclusive. Patients who were managed according to the grading scale were compared with those in whom the scale was not used at the time of admission but was calculated retrospectively. There were 49 admissions in 30 patients during the study period, of which 49 (100%) were in Indigenous Australians, 29 (59%) were male and the median age was 44.1 years. According to the grading scale, 8 (16%) episodes were mild, 24 (49%) were moderate, and 17 (35%) were severe. Readmission within the study period was significantly more likely with increasing disease severity, with an odds ratio (95% CI) of 12.8 (1.3-130) for severe disease compared with mild. The patients managed according to the grading scale (29 episodes) did not differ from those who were not (20 episodes), but they received fewer doses of ivermectin and had a shorter length of stay (11 vs. 16 days, p = 0.02). Despite this the outcomes were no different, with no deaths in either group and a similar readmission rate. CONCLUSIONS/SIGNIFICANCE: Our grading scale is a useful tool for the assessment and management of crusted scabies. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/24069468/full_citation L2 - http://dx.plos.org/10.1371/journal.pntd.0002387 DB - PRIME DP - Unbound Medicine ER -