Scabies: An updated review from epidemiology to current controversies and future perspectives

Scabies is a highly contagious parasitic dermatosis caused by the mite Sarcoptes scabiei var. hominis, affecting over 200 million individuals globally and imposing a significant health burden. Traditionally linked to low socioeconomic status and overcrowding, its prevalence is rising globally, especially among urban and institutional settings. Beyond its cutaneous manifestations, secondary bacterial complications contribute to significant morbidity, particularly in endemic areas. Advances in non-invasive imaging techniques including ultraviolet dermoscopy, reflectance confocal microscopy and line-field confocal optical coherence tomography, have improved diagnostic accuracy, while molecular assays show promise for enhanced sensitivity. Conventional diagnostics remain dependent on clinical evaluation and microscopic identification of mites, eggs, or scybala. First-line treatment involves topical and systemic therapies, and topical permethrin, benzyl benzoate, and oral ivermectin are commonly recommended in international guidelines. Emerging drug resistance has prompted research toward optimizing drug regimens and novel therapies, including moxidectin and combination treatments. Outbreaks of scabies in institutional settings, as well as endemic disease in those with limited resources, demonstrate the importance of coordinated public health efforts in the form of early case detection, simultaneous treatment of contacts and other environmental control measures. In this review, we present an updated and thorough description of scabies, covering the relevant epidemiology, clinical picture and the new diagnostic methods. In summary, by combining new updates and essential unanswered questions, this review describes the current dilemma and covers the latest data in the field.