Retrospective Evaluation of Misdiagnosed Scabies Cases: Clinical and Epidemiological Features and Resemblance to Other Dermatological Conditions

Gülbaşaran F., Özbağcivan Ö., Öner S., Çapkan O.

Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi, vol.37, no.3, pp.281-290, 2024 (Peer-Reviewed Journal)


Background and Aim: Diagnosing scabies, a skin condition caused by mites, can be challenging due to its resemblance to other skin problems. Avoiding misdiagnoses could result in a significant reduction in treatment delays and complications. Our objective was to investigate scabies cases that initially posed diagnostic challenges.
Methods: This retrospective study focused on scabies patients who were initially misdiagnosed despite routine clinical examinations and underwent histopathological examinations with different preliminary dermatological diagnoses. Inclusion criteria were in accordance with the 2020 International Alliance for the Control of Scabies Diagnosis Criteria. The study retrospectively compiled clinical, histopathological, and demographic characteristics, providing data on the challenges and delays in diagnosing scabies cases that mimic other dermatological conditions.
Results: In a cohort of 27 scabies cases with diagnostic challenges, the majority were females (63%) with a mean age of 64.8±15.9 years. Pre-admission, 66.7% of the patients used systemic antihistamines, 52.4% used immunosuppressants, and 42.9% used topical scabies treatment. Secondary xerosis cutis and contact dermatitis were noted in 11.1% and 7.4% of cases. The most frequently considered differential diagnoses by dermatologists included prurigo subacuta (29.6%), dermatitis herpetiformis (18.5 %), lymphomatoid papulosis (14.8%), and vesicular/bullous pemphigoid (11.1 %).
Conclusion: Previous treatments; prolonged infestations leading to severe secondary dermatological problems including prurigo subacuta, contact dermatitis, and xerotic eczema; atypical distribution of lesions; female prurigo; and elderly with prolonged pruritic atypical dermatoses or vesicular/bullous presentations should be kept in mind as clinical scenarios that may contribute to a delay in the diagnosis of scabies.