Psychological and behavioral burden of scabies: a comprehensive cross-sectional analysis of pruritus, anxiety, behavioral adaptation, and quality of life

BACKGROUND: Scabies is a readily transmissible parasitic skin disease frequently seen in primary care and characterized by intense pruritus. While its clinical features are well described, the psychological and behavioral aspects of scabies, including anxiety, maladaptive behaviors, and their effect on quality of life, remain insufficiently explored. OBJECTIVES: The aim of this study was to evaluate the clinical, psychological, and behavioral impact of scabies and to examine the associations between anxiety, behavioral changes, pruritus severity, and dermatology-related quality of life (DLQI). METHODS: In this cross-sectional study, adults with confirmed scabies, diagnosed according to the 2020 International Alliance for the Control of Scabies (IACS) criteria, were included. Participants completed an online questionnaire assessing pruritus severity, pre- and post-treatment pruritus duration, behavioral changes, anxiety measured by the Generalized Anxiety Disorder-7 (GAD-7), and DLQI. Non-parametric tests, Spearman correlation analyses, and multivariable linear regression with robust standard errors were used to evaluate associations between clinical and psychosocial variables. RESULTS: A total of 173 participants were analyzed (median age 37 years [IQR 27-46]; 48.6% female). Median pruritus severity was high (8.0 [7.0-10.0]), while median GAD-7 and DLQI scores were 4.0 [2.0-7.0] and 8.0 [1.0-18.0], respectively. Pruritus severity was significantly correlated with behavioral change (ρ = 0.27, p < 0.001) but not with anxiety or quality-of-life impairment. In contrast, DLQI showed significant correlations with anxiety (ρ = 0.379, p < 0.001) and behavioral change (ρ = 0.211, p = 0.005). Pre-infestation fear of scabies was associated with nearly two-fold higher anxiety scores (median GAD-7 7.0 vs. 3.5, p < 0.001) and greater behavioral change. Nodular scabies independently predicted greater impairment in quality of life in multivariable analysis (β = 3.25, p = 0.047). CONCLUSIONS: Quality-of-life impairment in scabies was more closely related to anxiety scores and nodular presentation than to itch intensity alone. Anxiety and behavioral responses were significantly associated with DLQI scores, suggesting that management should address more than antiparasitic treatment and include psychological and behavioral dimensions. As most patients are initially evaluated in primary care, these factors can be assessed during early consultations, alongside standard treatment.