Poor Prognosis of Scabies in Atopic Children in Bangladesh

Open Access

Abstract

Background: Scabies is a significant pediatric health problem in Bangladesh, with atopic children often presenting with disproportionately severe symptoms and delayed recovery. Underlying atopic conditions may worsen clinical manifestations and affect treatment outcomes, yet evidence on their prognostic impact remains limited. Aim of the study: To evaluate whether atopic children in Bangladesh have a poorer prognosis of scabies compared with non-atopic children. Methods & Materials: This prospective observational study enrolled 120 children aged 0-14 years with clinically diagnosed scabies between 01.02.2025 to 30.10.2025 at the Department of Dermatology, Ashiyan Medical College Hospital, Dhaka, Bangladesh and Enam Medical College and Hospital, Dhaka, Bangladesh. Participants were stratified into atopic (n = 60) and non-atopic (n = 60) groups based on clinical history, family history, and laboratory parameters (total serum IgE and eosinophil counts). Data on demographics, clinical features, environmental risk factors, laboratory investigations, treatment response, and outcomes were collected using structured forms. All children received standard first-line therapy with topical permethrin ± antihistamines. Statistical analyses included t-tests, Chi-square tests, and multivariate logistic regression to identify independent predictors of poor prognosis. Result: Atopic children demonstrated significantly greater disease severity, with higher pruritus scores (8.2 ± 1.2 vs. 6.5 ± 1.5, p < 0.001), larger body surface area involvement (22.4% ± 11.0 vs. 14.8% ± 8.5, p < 0.001), and increased rates of nocturnal itching, sleep disturbance, eczematization, and secondary bacterial infection. Response to first-line therapy was lower in atopic children (complete response: 50% vs. 70%, p = 0.003), requiring more treatment cycles andlonger time to clinical improvement (9.5 ± 4.2 vs. 5.8 ± 3.1 days, p < 0.001). Atopic status independently predicted poor prognostic outcomes, including prolonged disease (>4 weeks) and secondary infection. Environmental factors such as shared bedding, prior family exposure, and poor hygiene were more prevalent in the atopic group. Conclusion: Atopic children experience significantly worse scabies outcomes in Bangladesh, with more severe disease and delayed recovery. Early identification and tailored management are essential to improve prognosis.