Can A Simplified Exam Correctly Identify Scabies?



A simplified examination of the hands, feet, and legs could diagnosis approximately 90% of scabies cases, according to the findings of a recent study.


“With the recent recognition of scabies as a neglected tropical disease by the World Health Organization there is a need for standardized approaches to disease mapping to define populations likely to benefit from intervention, and to measure the impact of interventions,” the researchers wrote. Currently, full body examinations are used to diagnose scabies, but these can be time-consuming and intrusive.

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In their study, the researchers assessed the ability of a simplified clinical exam to diagnose scabies using data from 3 population-based surveys, which included 1373 individuals with scabies. Individuals in the survey were diagnosed with scabies based on whole body assessments and assessments of 9 individual body regions. The researchers calculated the sensitivity of diagnosing scabies based the individual body regions compared with whole body exam, as well as identified regions with greater than 90% sensitivity. In addition, sensitivity was assessed based on gender, age, severity of scabies, and presence or absence of impetigo.


The hands had the highest diagnostic yield, with sensitivity of 51.2% compared with whole body examination, followed by feet (49.7%), and lower legs (48.3%). Examination of the exposed parts of arms and legs had a sensitivity of 93.2%. Additionally, the researchers found that the sensitivity of the simplified exam was greater than 90% regardless of scabies severity or the presence or absence of secondary impetigo.


“Our study adds valuable data to the development of a simplified diagnostic process for scabies that may be applied to guide decisions about future public health interventions,” the researchers concluded. “Further studies in other settings are needed to prospectively validate this simplified approach.”



Marks M, Engelman D, Romani L, et al. Exploration of a simplified clinical examination for scabies to support public health decision-making [published online December 27, 2018]. PLoS Negl Trop Dis. doi:10.1371/journal.pntd.0006996