Secondary skin infections following scabies in children: clinical findings and risk factors

Purpose: This study aimed to identify the clinical and behavioral risk factors associated with secondary bacterial skin infections in children with scabies. Materials and Methods: We retrospectively reviewed records of 200 children (0–18 years) diagnosed with scabies between January 2022 and December 2024. All received a two-dose permethrin regimen and were followed for 30 days. Collected data included age, sex, pruritus severity, symptom-to-diagnosis interval, treatment adherence, and household contact treatment.. Results: Secondary skin infection occurred in 35% of children at a median of 9 days (Interquartile range (IQR) 6–12) after treatment. The median interval from symptom onset to scabies diagnosis was 11 days (IQR 8–15). In bivariate analyses, infected children were younger ( median age 7.5 vs. 8.5 years) and had higher pruritus scores (7.0 vs. 5.0). Multivariable analysis identified five independent predictors. Younger age (adjusted odds ratio (aOR) 0.92 per year; 95% confidence interval (CI) 0.85–0.99), higher pruritus score (aOR 1.18 per point; 95% CI 1.06–1.31), longer symptom-to-diagnosis interval (aOR 1.10 per day; 95% CI 1.02–1.19), incomplete topical application (aOR 2.9; 95% CI 1.3–6.4) and failure to treat household contacts (aOR 3.7; 95% CI 1.6–8.5). Impetigo (48.5%) and cellulitis (24.6%) were the most frequent manifestations. Conclusion: Early diagnosis, complete topical application, household treatment, and monitoring pruritus severity are key to reducing secondary infections in pediatric scabies.