Factors Affecting Topical Treatment Success in Pediatric Scabies Cases: A Cross-Sectional Study

INTRODUCTION: Scabies is a common disease that affects the pediatric population. Treatment failure and relapse occur frequently in children. OBJECTIVES: We aimed to identify the factors that affect topical treatment success in pediatric scabies patients. METHODS: A multicenter cross-sectional study was conducted from April 2022 to December 2022. Pediatric scabies cases were classified as belonging to either the treatment failure (TF) group or the treatment success (TS) group. RESULTS: We enrolled 170 patients for the study. In the TF group, the presence of symptomatic household members and referrals from physicians other than dermatologists were more common (both P < 0.001), and relapse rates and total symptom duration were higher (P = 0.007, P < 0.001, respectively). Regarding treatment agents, 5% permethrin was more commonly used in the TF group (71.1% versus 25%; P < 0.001). The proportion of patients treated with sulfur preparations was significantly higher in the TS group (60.7% versus 16.9%; P < 0.001). Misapplication of topical therapy was significantly more common in the TF group (P < 0.001), with statistically significant errors being (i) lack of treatment of close contacts (p<0,001), (ii) single application (P < 0.001), and (iii) local application (P = 0.027). A multivariate analysis revealed that TS was mainly associated with (i) the presence of atopy (odds ratio [OR] 6.12, 95% CI: 1.39–27.04), (ii) the absence of symptomatic household members (OR 6.31, 95% CI: 2.14–18.63), and (iii) presentation to a dermatologist rather than another specialist (OR 6.51, 95% CI: 2.11–20.13). The use of permethrin negatively affected treatment success (OR 0.22, 95% CI: 0.07–0.71). CONCLUSIONS: Pediatric scabies patients should be treated before other family members become infested and with topicals other than permethrin. In addition, awareness of scabies needs to be increased among non-dermatologists.