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A Novel Clinical Grading Scale to Guide the Management of Crusted Scabies

Davis, Joshua S., McGloughlin, Steven, Tong, Steven Y. C., Walton, Shelley F. and Currie, Bart J. (2013). A Novel Clinical Grading Scale to Guide the Management of Crusted Scabies. PLoS Neglected Tropical Diseases,7(9):e2387-1-e2387-5.

Document type: Journal Article
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IRMA ID bsmithxPUB203
Title A Novel Clinical Grading Scale to Guide the Management of Crusted Scabies
Author Davis, Joshua S.
McGloughlin, Steven
Tong, Steven Y. C.
Walton, Shelley F.
Currie, Bart J.
Journal Name PLoS Neglected Tropical Diseases
Publication Date 2013
Volume Number 7
Issue Number 9
eISSN 1935-2735
Scopus ID 2-s2.0-84884687502
Start Page e2387-1
End Page e2387-5
Total Pages 1
Place of Publication United States of America
Publisher Public Library of Science
HERDC Category C1 - Journal Article (DIISR)
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.

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

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Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 4.0 License

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