Ewha Med J.  2024 Oct;47(4):e73. 10.12771/emj.2024.e73.

Clinical practice guidelines for the diagnosis and treatment of scabies in Korea: Part 1. Epidemiology, clinical manifestations, and diagnosis — a secondary publication

• Park J
• Kwon SH
• Lee YB
• Kim HS
• Jeon JH
• Choi GS
• on behalf of the Scabies Study Group of Korean Dermatological Association

• KMID: 2561424
• DOI: http://doi.org/10.12771/emj.2024.e73

Abstract

Scabies is a skin disease caused by the parasite Sarcoptes scabiei var. hominis, which is primarily transmitted via direct skin or sexual contact or, less commonly, via contact with infested fomites. In Korea, the incidence of scabies has decreased from approximately 50,000 cases per year in 2010 to about 30,000 cases per year in 2021. However, outbreaks are consistently observed in residential facilities, such as nursing homes, especially among older adults. The clinical manifestations of scabies vary based on the patient’s age, health status, the number of mites, and the route of transmission. Typical symptoms of classic scabies include intense nocturnal itching and characteristic skin rashes (burrows and erythematous papules), with a predilection for the interdigital web spaces, inner wrists, periumbilical areas, axillae, and genital areas. In contrast, older adults with immunodeficiency or neurological disorders may exhibit hyperkeratotic scaly lesions or an atypical distribution with mild to no itching (crusted scabies). The diagnosis of scabies is based on clinical symptoms and the results of diagnostic tests aimed at identifying the presence of the parasite. While a history of close contact and characteristic clinical findings suggest scabies, confirmation of the diagnosis requires detecting scabies mites, eggs, or scybala. This can be achieved through light microscopy of skin samples, noninvasive dermoscopy, and other high-resolution in vivo imaging techniques.

Keyword

Diagnosis; Epidemiology; Practice guideline; Sarcoptes scabiei; Scabies

Figure

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  Fig. 1. Epidemiology of scabies in Korea, 2010–2021. (A) Incidence rate. (B) Age-standardized incidence rate. (C) Age distribution of patients.

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  Fig. 2. Clinical photographs of scabies. (A,B) Characteristic classic scabies showing burrows in the interdigital web space. (C,D) Typical erythematous macules, papules, and excoriated crusts in the typical distribution (axilla, groin) of classic scabies. (E,F) Atypical clinical features of scabies in infants showing palmoplantar involvement or atypical skin lesions, such as wheals or vesicles. (G) Crusted scabies revealing diffuse hyperkeratotic scaly lesions in immunocompromised individuals. (H) Nodular scabies revealing multiple nodules in the scrotum.

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  Fig. 3. Burrow ink test (staining of the linear burrow with washable blue ink). (A) Naked eye examination, (B) hand-held polarized dermoscope (×10), and (C) high-resolution videodermoscope (×100; circle: burrow, arrowhead: scabies mite).

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  Fig. 4. Skin scraping method findings of scabies. (A–C) Skin scraping method. Adapted from Cho [7] with CC-BY-NC. (D,E) Microscopic findings from a skin scraping sample showing scabies mites, eggs, and scybala in vitro (×100).

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  Fig. 5. Dermoscopic findings of scabies in vivo. (A) A triangular mite (hang glider sign) and curvilinear burrow (jet with condensation trail; ×10). (B) Multiple scabies mites and feces within burrows in crusted scabies (×10). (C) Scabies mite using a high-resolution imaging device (×300).

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  Fig. 6. Histopathological findings of scabies showing a burrow in the stratum corneum with Sarcoptes scabiei mites (hematoxylin and eosin stain; ×400 [inset: ×40]).

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