|Year : 2018 | Volume
| Issue : 2 | Page : 660-663
Frequency of scabies among patients attending dermatology outpatient clinic in Qwesna Hospital, Menofia Governorate
Mohamed A Pasha1, Hala Shaheen2, Amira M Abdallah3
1 Department of Dermatology and Andrology, Faculty of Medicine, Menoufia University, Menofia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menofia, Egypt
3 Department of Dermatology and Andrology, Quesna Hospital, Menofia, Egypt
|Date of Submission||10-Dec-2016|
|Date of Acceptance||31-Mar-2017|
|Date of Web Publication||27-Aug-2018|
Amira M Abdallah
Quesna Hospital, Menoufia
Source of Support: None, Conflict of Interest: None
The aim of the paper was to assess and describe frequency of scabies in patients attending dermatology outpatient clinic in Quesna Hospital, Menoufia Governorate.
Scabies is a neglected health problem worldwide. It is a highly contagious skin disease that affects both males and females of all socioeconomic status. It is related primarily to poverty and overcrowding. Clinically, it presents as a small erythematous papulovesicular rash, generally symmetrical.
Patient and methods
This was a descriptive cross-sectional study conducted in the outpatient clinic of dermatology at Quesna Hospital. The calculated sample was 370 patients. Patients were assessed using semistructured questionnaire. Examination was conducted for all patients. Data collected were analyzed using Microsoft Excel SPSS version 16 software programs.
In this study, 27 cases were diagnosed as having scabies, giving a frequency rate of 7%, and 343 (93%) patients were diagnosed as not having scabies. Of the patients with scabies, 48.1% were males and 51.9% were females. The most common age ranged from 30 to 49 years (33.3%). Scabies was more prevalent among families of larger size (44.4%), with crowding index less than 2 (55.6%), and with low socioeconomic level (92.6%). Itching increased at night in 96.3% of the patients.
It is clearly shown by our study that personal hygiene plays an important role in the development of scabies. Respondents who share towel with others are more prone to development of scabies.
Keywords: contagious, frequency, papulovesicular rash, scabies
|How to cite this article:|
Pasha MA, Shaheen H, Abdallah AM. Frequency of scabies among patients attending dermatology outpatient clinic in Qwesna Hospital, Menofia Governorate. Menoufia Med J 2018;31:660-3
|How to cite this URL:|
Pasha MA, Shaheen H, Abdallah AM. Frequency of scabies among patients attending dermatology outpatient clinic in Qwesna Hospital, Menofia Governorate. Menoufia Med J [serial online] 2018 [cited 2019 Sep 21];31:660-3. Available from: http://www.mmj.eg.net/text.asp?2018/31/2/660/239767
| Introduction|| |
Scabies is a neglected health problem worldwide. It is a highly contagious skin disease that affects both males and females of all socioeconomic status (SES) and race. It is related primarily to poverty and overcrowding . High prevalence rates of scabies were recorded in a community-based study in El-Tall El-Kabir (23.5%) . A cross-sectional study carried out among three rural representative areas of Assyut Governorate showed that the prevalence rate of scabies was 1.72% . The highest rates in developing countries were among preschool children to adolescents . Scabies affected both sexes similarly, although there was some variability between studies .
Clinically, scabies presents as a small erythematous papulovesicular rash, generally symmetrical. Areas most frequently affected are where the stratum corneum is thinnest with few hair follicles, commonly including anterior axillary folds, nipple area in females, periumbilical skin, elbows, volar surface of the wrists, interdigital web spaces, belt line, thighs, buttocks, penis, scrotum, and ankles, and it spares the head, face, and neck in adults, although can be affected in infants during breast feeding and in immunocompromised individuals . Currently, there is no efficient means of diagnosing human or animal scabies. Diagnosis is via clinical signs and microscopic examination of skin scrapings, but experience has shown that the sensitivity of these traditional tests is less than 50% . Immediate treatment of the patient with an effective drug and vigorous treatment of close contacts remains the mainstay in case management. Treatment must be coordinated to minimize the risk of treatment failure. All cases, household contacts, and fomites should be treated concurrently . The aim of this study is to assess and describe the frequency of scabies in patients attending dermatology outpatient clinic in Quesna Hospital, Menoufia Governorate.
| Patients and Methods|| |
The present study was carried out in Quesna City, Menoufia Governorate, Egypt, during the period from the beginning of November 2015 to the end of February 2016 in the dermatology outpatient clinic, Quesna Centralized Hospital. The sample size was 367. The patients were chosen through random sample technique. All the patients who attended the dermatology outpatient clinic at Quesna Centralized Hospital were included in the study. All subjects were clinically diagnosed as having scabies by physical examination which was done for all patients including predilection sites of infestation, burrows and vesicles, excoriations, and any skin eczema. A complete questionnaire was taken regarding patients' demographic characteristics such as age, sex, residence, occupation, size of the family, hospital admission, possible source of infestation, and duration of symptoms.
Data were statistically analyzed by using statistical package for the social sciences version 16 software (SPSS Inc., Chicago, Illinois, USA). Data were represented as number and percentage. χ2 and Fisher exact tests were used, when appropriate. P less than or equal to 0.05 was considered statistically significant.
Ethical clearance was obtained from Ethics and Research Committee of Faculty of Medicine, whereas permission to conduct the study was obtained from the head of Quesna Centralized Hospital. Individual informed consent was obtained verbally from the patients.
| Results|| |
In this study, 370 patients attending the outpatient clinic of dermatology at Quesna Hospital were screened for scabies. A total of 27 cases were diagnosed as having scabies, giving a frequency rate of 7%, and 343 (93%) patients were diagnosed as not having scabies [Figure 1].
|Figure 1: Frequency rate of scabies among all studied patients (N = 370).|
Click here to view
There were 48.1% males and 51.9% females. The most common age ranged from 30 to 49 years (33.3%), and 3.7% of the patients were aged more than 60 years. It was noticed that scabies more commonly presented in unemployed patients (51.5%) followed by farmers (18.5%) and employers (11.1%). There was a statistical significant difference regarding age and occupation between the different studied groups (P < 0.05). There was no statistical significant difference regarding sex between the different studied groups (P > 0.05) [Table 1].
Scabies occurred more frequent in those with family size of six (44.4%) members, having number of rooms less than four (96.3%), and with crowding index less than 2 (55.6%). The most patients with scabies were of low SES (92.6%). There was no statistical significant difference regarding family size, number of rooms, crowding index, and SES between the different studied groups (P > 0.05) [Table 2].
|Table 2: Comparison between studied groups regarding, family size, crowding index, and socioeconomic level|
Click here to view
Overall, 63% of patients had similar manifestations in the family. Itching increased at night in 96.3% of patients. Scabies most common presented clinically by scratch markings (70.4%). The most common site was hands and trunk (100% each), followed by axilla (92.6%), genitalia (81.48%), buttocks (70.37%), feet and legs (66.7% each), and breasts (7.4%) [Table 3].
|Table 3: Family history of studied group, if manifestations increase at night, shape of the skin lesion, and site of lesion|
Click here to view
| Discussion|| |
Scabies is a contagious skin disease infecting humankind for centuries. It is usually transmitted by direct skin-to-skin contact, but fomites play a role in the contagiousness of scabies to some extent . In this study, the frequency rate was 7%. On the contrary, a study conducted by El-Akhras et al. , as a community-based survey in El-Tall El-Kabir, found high prevalence rate of scabies at 23.5%. This study confirmed that there was a higher prevalence of scabies among females (51.9%). It can be explained because females are usually more in contact with children or sometimes domestic animals, which are considered as sources of infection. Jackson et al.  and Lassa et al.  observed similar results, as there was a significantly greater infection rate among females, with a relative risk of 1.24, more than males. In this study, the ages of patients with scabies ranged from 30 to 49 years, which was statistically significant (P < 0.05). This results can be explained because the patients who were attending the dermatology clinic were mostly from this age group as those younger than this age were at their schools at the time of clinic and related also with hospital of assurance and ages above are geriatrics and found problems in attendance the hospital alone. Contrary to this study, Nashaat et al.  confirmed that there was a higher prevalence of scabies among females (51.9%). In this study, it was observed that scabies presence was more in houses with rooms less than four (96.3%), family members of six (44.4%), and crowding index less than 2 (55.6%). It was noticed also there was no statistical significant difference regarding family size, number of rooms, and crowding index (P > 0.05). It can be explained by the fact that hygiene is an important factor in transmission of scabies as it is relates to personal contact, sharing of sleeping garments and bed linen, and infrequent laundering of clothes and bedding . Similar to this study, Al-Shawa  observed that scabies presence was more in houses with rooms less than four (45.5%), with family members more than six (43%), and crowding index is of 2 (47%); Al-Musawi  showed that scabies was more prevalent among persons who had large family size (54%). In the current study, it was noticed that scabies was more prevalent in patient with low SES (92.6%), as it was difficult to treat scabies because of a lack of ability to pay treatment costs owing to unemployment. El-Akhras et al.  observed similar results as scabies affected more patients of very low (87.8%) and low SES (87.5%) than middle SES (85.8%) and high SES (76.7%). In this study, it was observed that 63% of patients had a positive family history of itchy lesions owing to prolonged personal contact with an infected person and therefore is common among family members. Some studies showed similar results, as Buczek  showed that the most important risk factor for scabies was 'history of itch in other family members'. In this study, it was noticed that scabies most commonly presented clinically by scratch markings (70.4%) followed by vesicular lesion (22.2%) and macules (7.4%). Al-Shawa  noticed similar results as scabies presented with papules (53%), vesicular lesions (37%), nodules (5.9%), and erythema (2.9%). In this study, it was noticed that the most common site was hands and trunk (100% each) followed by axilla (92.6%), genitalia (81.48%), buttocks (70.37%), feet and legs (66.7% each), and breast (7.4%). There was no statistical significant difference regarding distribution of the lesion (P > 0.05). Al-Musawi  found similar results as the most common site was hands and trunk (100%) followed by axilla (92.3), genitalia (91.1), buttocks (77.4), feet (72.6%), legs (69.6%), and breast (6%), and head and neck (4.8%).
Collectively, the relationship between the prevalence of scabies and the relative levels of poverty, crowding, and hygiene within a community is complex.
| Conclusion|| |
It is clearly shown by our study that personal hygiene plays an important role in the development of scabies. Respondents who share towel with others are more prone to development of scabies. There is a need for public health programs to educate the population to understand the preventive aspects of diseases like scabies.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Feldmeier H, Heukelbach J. Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues. Bull World Health Organ 2009; 87
El-Akhras A, Sonbol O, Khattab M. Prevalence of skin diseases in rural area in Egypt. Zeitschrift für Gastroenterologie 1992; 6
Abdel-Hafez K, Abdel-Aty MA, Hofny ERM. Prevalence of skin diseases in rural areas of Assiut Governorate, Upper Egypt. Int J Dermatol 2003; 42
Muhammad ZM, Saidatul SR, Adil AR, Rohela M, Jamaiah I. Prevalence of scabies and head lice among children in a welfare home in Pulau Pinang, Malaysia. Trop Biomed 2010; 27
Hicks MI, Elston DM. Scabies. Dermatol Ther 2009; 22
Currie BJ, McCarthy JS. Permethrin and ivermectin for scabies. N Engl J Med 2010; 362
Walton SF, Currie BJ. Problems in diagnosing scabies, a global disease in human and animal populations. Clin Microbiol Rev 2007; 20
Monsel G, Chosidow O. Management of scabies. Skin Ther Lett 2012; 17
Park JH, Kim CW, Kim SS. The diagnostic accuracy of dermoscopy for scabies. Ann Dermatol 2012; 24
Jackson A, Heukelbach J, Feldmeier H. Transmission of scabies in a rural community. Braz J Infect Dis 2007; 11
Lassa S, Campbell MJ, Bennett CE. Epidemiology of scabies prevalence in the UK from general practice records. Br J Dermatol 2011; 164
Nashaat EN, Nadia SE, Salwa AS, Amira MM. Assesment of different diagnostic methods for scabies with follow-up of cellular immune response. J Menofia Med 2015; 28
Hegazy AA, Darwish NM, Abdel-Hamid IA, Hammad SM. Epidemiology and control of scabies in an Egyptian village. Int J Dermatol 2008; 38
Al-Shawa RM. The epidemiology of scabies in Gaza Governorates. J Azhar Univ Gaza Nat Sci 2007; 9
Al-Musawi M, Hasan HR, Maluki AH. Prevalence of scabies among patients attending the Dermatology Outpatient Clinic in Najaf Governorate, Iraq Res 2013; 3
Buczek A. Epidemiological study of scabies in different environmental conditions in Central Poland. Ann Epidemiol 2006; 16
[Table 1], [Table 2], [Table 3]