Dermatology: Practical and Conceptual Original Article | Dermatol Pract Concept. 2025;15(2):4979 1 Pediatric Scabies: Association with Sleep Disorders, Anxiety, Depression, and Impaired Quality of Life Nihal Sarı1, Gülsüm Yitik Tonkaz2, Şeyda Arslan3 1 Giresun University Faculty of Medicine, Department of Dermatology and Venereology, Giresun, Turkey 2 Giresun University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Giresun, Turkey 3 Bulancak State Hospital, Department of Family Medicine, Giresun, Turkey Key words: Anxiety, Depression, Pediatric scabies, Quality of life, Sleep disorders Citation: Sarı N, Tonkaz GY, Arslan S. Pediatric Scabies: Association with Sleep Disorders, Anxiety, Depression, and Impaired Quality of Life. Dermatol Pract Concept. 2025;15(2):4979. DOI: https://doi.org/10.5826/dpc.1502a4979 Accepted: November 13, 2024; Published: April 2025 Copyright: ©2025 Sarı et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Nihal Sarı. Giresun University Faculty of Medicine, The Department of Dermatology and Venereology, Giresun, Turkey. Gazipaşa Yerleşkesi Debboy Mevki Giresun/Türkiye, Giresun 28200, Turkey. ORCID ID: 0000-0001-6004-6113. E-mail: nihal02_kyl@hotmail.com Introduction: Scabies is a contagious, infectious skin disease that is observed worldwide. Scabies affects individuals of all ages, although it exhibits significant differences between childhood and adult- hood. While the number of publications documenting the co-occurrence of anxiety, depression, and impaired quality of life (QoL) in adult patients with scabies is increasing, the presence of these issues in pediatric patients remains a topic of curiosity. Objectives: In this study, we aimed to investigate the presence of sleep disorders, QoL, anxiety, and depression in children with scabies. Methods: In this analytical case-control study, 68 scabies patients and 69 healthy controls aged 6–17 years were included. Results: In patients with scabies, sleep quality was significantly poorer compared to the control group (P<0.001). There was no difference between the two groups in terms of RCADS (Revised Chil- dren’s Anxiety and Depression Scale) and total anxiety and depression scores. In the control group, the number of individuals with upper and upper-middle socioeconomic levels was higher (P=0.036). A moderate correlation was found between impairment in dermatology-related QoL and deterioration in sleep quality in patients with scabies (r=0.606, P<0.001). Conclusion: This study found that sleep disorders are common among children diagnosed with sca- bies, negatively impacting their QoL compared to healthy controls. We believe that obtaining informa- tion about both night and day sleep patterns during dermatological follow-ups of children diagnosed with scabies and providing recommendations on sleep hygiene as part of the treatment process may have positive effects on a child’s QoL. ABSTRACT 2 Original Article | Dermatol Pract Concept. 2025;15(2):4979 Introduction Scabies is a contagious, infectious skin disease that is com- mon worldwide and is caused by the mite Sarcoptes scabiei var hominis (S. scabiei). Scabies observed in humans can af- fect all races and social classes in every climatic condition [1]. Scabies, which affects individuals of all ages, is most com- monly seen in infants and children and differs from adults in many ways during childhood [2]. Nocturnal pruritus, frequently observed in pediatric patients diagnosed with scabies, significantly affects children’s sleep patterns and quality, with the quality and duration of sleep influencing the child’s daily performance, emotional state, and mental health. Children who do not get adequate sleep may expe- rience restlessness, irritability, and difficulty coping with their emotions [3]. Prolonged sleep disturbances can increase the risk of depression and anxiety disorders in children, ad- versely impacting their QoL [4]. Therefore, whether anxiety and depression accompany psychiatric disorders in pediatric scabies patients is a subject of interest. Objectives In this study, we aimed to investigate sleep disturbances, QoL, presence of anxiety disorders, and depression in chil- dren diagnosed with scabies. Methods Sample This analytical case-control study included a total of 68 sca- bies patients and 69 healthy controls aged 6–17 years who presented to our hospital (Dermatology and Family Medi- cine clinics) between June 2023 and March 2024. Informed consent was obtained from all participants. This study was conducted in accordance with the Helsinki Declaration. Prior to commencement, the study protocol was approved by the Clinical Research Ethics Committee of Research Hos- pital (approval number: 19.06.2023/07, date: 19.06.2023). G*Power (V3.1) software (Informer Technologies, Inc., Los Angeles, USA) was used to calculate the required sample size. Using data from a previous study, the effect size in sample size calculation was found to be 0.44 [5]. Based on a power of 80% and a 5% level of significance, the total sample size required was calculated as 65. Implementation The diagnosis of scabies was based on the 2020 Interna- tional Alliance for the Control of Scabies (IACS) Consen- sus Criteria [6]. Individuals under 6 years old (non-literate) and over 17 years old, those with chronic systemic diseases, other pruritic dermatoses, psychiatric disorders, and using any mood-altering drugs were excluded from the study. All participants completed a sociodemographic data form and socioeconomic status index questionnaire. Parents of par- ticipants completed the DSM-5 Level 2- Sleep Disturbance Scale, and participants completed the Revised Children’s Anxiety and Depression Scale. Additionally, children diag- nosed with scabies were asked to complete the Children’s Dermatology Life Quality Index (CDLQI). Data Collection Instruments Clinical and Dermatoscopic Evaluation Patients underwent a full-body skin examination, and sus- pected areas for parasites were imaged using hand dermatos- copy (DermLite DL4, x10; in polarized and non-polarized modes). According to the 2020 IACS Consensus Criteria, patients diagnosed with “confirmed scabies” were included if dermoscopically at least one mite burrow was visualized. Additionally, during dermatological examination, lesion type and locations were recorded. The topographical distribution of lesions and affected skin surface were categorized into 14 regions: interdigital spaces, legs, hands, feet, wrists, ab- domen, arms, chest, elbows, breasts and areola, axilla, back, genital/groin, and buttocks. Based on the number of areas with lesions, patients were classified into categories: 1–3 re- gions, 4–6 regions, 7–9 regions, and ≥10 regions [6]. Sociodemographic Data Form This form, prepared by the researchers, included information regarding the participants and their family members. It re- corded demographic details such as age, sex, education level, settlement, number of siblings, ages, sexes, and education levels of other family members, duration between disease onset and diagnosis, and history of scabies treatment. Socioeconomic Status (SES) Index This index is classified based on four primary variables, in- cluding the community’s location and type of housing, av- erage education level of household members, employment status and positions of household members, and assets owned by the household. Scores on this index range from a minimum of 4 to a maximum of 20 points. According to these scores, the community is categorized into five socio- economic levels labeled from highest to lowest: A (upper), B (upper-middle), C1 (middle), C2 (lower-middle), and D (lower), based on this classification [7]. Children’s Dermatology Quality of Life Index (CDLQI) This scale consists of ten questions that can be directed to- wards children aged 4–16 years. It evaluates the previous week using a 4-point Likert scale. Higher scores indicate Original Article | Dermatol Pract Concept. 2025;15(2):4979 3 more severe impairment in QoL. We used the Turkish ver- sion of the scale, the validity and reliability of which was de- termined by Didar Balcı et al. [8]. The total score determines the extent to which QoL is affected: 0–1 points: no effect, 2–6 points: small effect, 7–12 points: moderate effect, 13–18 points: large effect, 19–30 points: very large effect [8]. DSM-5 Level 2 - Sleep Disturbance Scale This form, filled out by parents/legal guardians, evaluates specific sleep disturbances in children and adolescents aged 6–17 years using the 8-item PROMIS (Patient-Reported Outcomes Measurement Information System) Short Form for Sleep Disturbances. We used the Turkish version of the scale, the validity and reliability of which was confirmed by Erkuran et al. [9]. Each item asks the parent/legal guardian to rate the severity of their child’s sleep disturbance over the previous 7 days on a 5-point scale (1=never; 2=rarely; 3=sometimes; 4=often; and 5=always). The total score ranges from 8 to 40, with higher scores indicating more severe sleep disturbances [9]. Revised Children’s Anxiety and Depression Scale (RCADS) Developed to assess depression and anxiety in children and adolescents based on DSM-IV diagnostic criteria, the RCADS consists of 47 items. The RCADS Child Form uses a 4-point Likert-type scale where individuals rate the frequency of symptoms and behaviors related to anxiety and depression (never=0, sometimes=1, often=2, always=3). In addition to the total anxiety score (sum of five anxiety subscales) and the total anxiety-depression score (overall sum of all sub- scales), it includes six subscales: separation anxiety, gener- alized anxiety, panic, social phobia, obsession/compulsion, and depression. The Turkish validity and reliability study was conducted by Görmez et al. [10]. Statistical Analysis The data were transferred to computer environment and analyzed using IBM SPSS (version 21.0) package program. Descriptive statistics in the study are presented as mean ± standard deviation or median, depending on the nor- mal distribution of the data. Pearson’s chi-squared test or Fisher’s exact test was used to compare categorical variables. Shapiro-Wilk Test was used to assess the normal distribution of variables. Accordingly, for variables where it was deter- mined that they did not conform to normal distribution and showed statistical significance in comparisons between two independent groups, the Mann-Whitney U Test was used. For variables where it was confirmed that variables con- formed to normal distribution, the Student’s t test was used to compare two independent groups. Skewness- Kurtosis normality distribution test was used to determine whether the measurements were suitable for normal distribution. Ac- cording to Tabachnick and Fidell (2013), Skewness-Kurtosis values should be between +1.5 and -1.5. Statistical signifi- cance level was set at P<0.05. Results The study included a total of 68 scabies patients and 69 control individuals. Among the patient group, 36 (52.9%) were female and 32 (47.1%) were male, while in the control group, 37 (53.6%) were female and 32 (46.4%) were male. A total of 137 children were included. The mean age was found to be 12.16 ± 3.34 years (range 6–17 years) in the patient group and 12.62 ± 3.14 years (range 7–17 years) in the con- trol group. Demographic data, socioeconomic levels, sleep disorder scale scores, and RCADS scores for anxiety and de- pression are shown in Table 1. There was no statistically sig- nificant difference between the two groups in terms of age, sex, or RCADS total anxiety and depression scores; there was a statistical difference in socioeconomic level between the patients and the control group (P=0.036). Accordingly, the rate of participants at upper (A) and upper-middle (B) socioeconomic levels was higher in the control group. Ac- cording to the sleep disorders scale score, a statistically significant deterioration in sleep quality was observed in the scabies patient group (P<0.001). Clinical characteris- tics of scabies patients are presented in Table 2. The mean duration of disease among scabies-infected children was 9.49  ±  10.27  weeks. Regional involvement evaluation in- dicated that the majority (55.9%) had involvement in 4–6 body regions (N=38). It was noted that 27 patients (39.7%) received one type, and 21 patients (30.9%) received two types of antiparasitic treatments. Eighteen patients (26.5%) did not receive any antiparasitic treatment for scabies. Data analyses of patients’ QoL and psychological tests are pre- sented in Table 2. No significant relationships were found between disease duration, socioeconomic status, and To- tal Anxiety & Depression score, CDLQI, and sleep quality (P>0.05) (Table  3). A positive correlation of low-to-very low intensity was observed between the number of antipar- asitic treatments received by patients and CDLQI and Sleep Disorders Scale scores, respectively (rs: 0.334, P=0.005; rs: 0.256, P=0.035) (Table 3). A moderate positive correla- tion was found between CDLQI score and Sleep Disorders Scale (r=0.606, P<0.001), and a low positive correlation was observed between Total Anxiety & Depression score and CDLQI score (r=0.311, P=0.010) (Table 3). A weak positive correlation was found between Sleep Disorders Scale and To- tal Anxiety & Depression score (r=0.467, P<0.001). When examining the classification of CDLQI in scabies patients, it was observed that 36.8% of patients experienced a very large effect on their QoL (Table 4). 4 Original Article | Dermatol Pract Concept. 2025;15(2):4979 Table 1. Demographic Features and Comparisons of Socioeconomic Status Index, Sleep Disorders Scale, RCADS (total anxiety and Total Anxiety & Depression Scores) Between Patients and Controls. Children Diagnosed With Scabies (N=68) Controls (N=69) p-value Age (years), mean ± SD 12.16±3.34 12.62±3.14 0.406t Sex, N (%) Female Male 36 (52.9%) 32 (47.1%) 37 (53.6%) 32 (46.4%) 0.936X² SES index, N (%) A (upper socioeconomic level) B (Upper-middle socioeconomic level) C1 (middle socioeconomic level) C2 (lower-middle socioeconomic level) D (lower socioeconomic level) 0 (0%)a 2 (2.9%)a 15 (22.1%)a 45 (66.2%)a 6 (8.8%)a 5 (7.2%)b 8 (11.6%)b 16 (23.2%)a 36 (52.2%)a 4 (5.8%)a 0.036f Sleep Disorders Scale, mean± SD 22.86±7.87 16.86±6.20 <0.001t Total Anxiety Score, mean± SD 33.68±20.83 33.70±19.29 0.996t Total Anxiety & Depression Score, mean± SD 42.60±26.69 42.20±24.63 0.927t Abbreviations: t: Independent Sample t-test; Χ²: Pearson’s chi-squared test; f: Fisher-Freeman-Halton exact test, a,b: Different letters indicate statistically significant differences between groups. SD = standard deviation; SES = socioeconomic status. Table 2. Disease-Related Information, Psychological Tests, and Life Qualities Among Scabies Patients. Children Diagnosed With Scabies (N=68) Mean±SD Median (Q1-Q3) Duration of scabies(weeks) 9.49±10.27 5.5 (4.0-13.5) CDLQI 14.60±7.11 13.5 (10.0-20.0) RCADS-Child Separation Anxiety Generalized Anxiety Panic Social phobia Obsessions/compulsion Depression Total anxiety scores Total anxiety & depression scores 5.65±4.27 6.71±4.26 6.65±6.10 9.10±5.89 5.62±4.18 8.93±6.69 33.68±20.83 42.60±26.69 4.5 (3.0-8.0) 6.0 (3.0-9.0) 4.0 (2.0-11.0) 8.5 (4.25-13.75) 5.0 (2.0-8.0) 8.0 (4.0-13.0) 30.5 (16.25-48.0) 38.5 (19.0-61.25) n(%) Clinical localization 1–3 region 4–6 region 7–9 region ≥10 region 5 (7,4%) 38 (55,9%) 16 (23,5%) 9 (13,2%) Treatment number None 1 type of treatment 2 types of treatment 3 types of treatment 4 types of treatment 18 (26.5%) 27 (39.7%) 21 (30.9%) 1 (1.5%) 1 (1.5%) Abbreviations: CDLQI = Children’s Dermatology Life Quality Index; RCADS = Revised Child Anxiety & Depression Scale; SD = standard deviation. Original Article | Dermatol Pract Concept. 2025;15(2):4979 5 Table 3. Correlation of Scabies Patients’ Data With Total Anxiety & Depression Scores, CDLQI and Sleep Disorders Scale (N=68). Total Anxiety & Depression CDLQI Sleep Disorders Scale Duration of scabies, weeks rs P 0.094 0.444 0.153 0.212 0.082 0.505 Treatment number rs P -0.003 0.980 0.334 0.005 0.256 0.035 SES rs P 0.093 0.451 0.115 0.351 0.093 0.450 CDLQI r P 0.311 0.010 1 0.606 <0.001 Sleep disorders scale r P 0.467 <0.001 0.606 <0.001 1 Abbreviations: r: Pearson correlation; rs: Spearman correlation. CDLQI = Children’s Dermatology Life Quality Index; SES = socioeconomic status Table 4. Banding of the Children’s Dermatology Life Quality Index (CDLQI) with the Scores for Patients With Scabies. Effect Severity Score N (%) No effect 0-1 2 (2.9%) Small effect 2-6 8 (11.8%) Moderate effect 7-12 20 (29.4%) Large effect 13-18 13 (19.1%) Discussion This study found that children diagnosed with scabies experi- ence disrupted sleep and lower QoL compared to the control group. However, there was no significant difference observed between the children diagnosed with scabies and the control group in terms of the frequency of depression and anxiety dis- orders. This case-control study found a significant difference in socioeconomic status between the two groups (P<0.05), with 66.2% of children diagnosed with scabies classified as C2 level and 22.1% as C1 level. None of the families of children with scabies belonged to the A level. Reviewing the literature, scabies is recognized as a significant public health problem in low and middle-income countries. The disease is endemic in many economically poor communities, with prevalence rates exceeding 20%. The contagiousness of the disease is influenced by social behaviors, migration, access to health services, crowded environments, housing, and hy- giene conditions [11]. The lower socioeconomic status of sca- bies patients we found in this study supports the literature. The most important symptom of scabies is intense pruritus, especially at night [12]. This itching is believed to result from a delayed hypersensitivity reaction to products from the S.scabiei [13]. In a study, itching at night was found to be a concurrent symptom in approximately 90% of infants and about half of adolescents diagnosed with scabies. Itching can lead to sleep disturbances and secondary bacterial infections due to scratching [1]. In this study, we observed that sleep disturbances were more prevalent in children diagnosed with scabies (P<0.05), based on the data we evaluated. Addition- ally, we found that dermatological QoL was lower in scabies- diagnosed children (P<0.05). Similarly, Worth et al. found that scabies significantly impacts the QoL of adults and children living in urban slums and impoverished conditions. Further- more, the nocturnal itching characteristic of the parasite, ex- acerbated by movement and warmth of the skin, can disrupt sleep patterns [14]. Disturbances in sleep patterns during the disease period may negatively affect children’s QoL. While the existing literature acknowledges the impact of itching on sleep quality, this study contributes significantly to the liter- ature by assessing and demonstrating this relationship using scales and exploring its impact on QoL. Although it is known that scabies negatively impacts children’s QoL and sleep, there is limited information regarding its effects on mental health during childhood. Studies in adults diagnosed with scabies have shown that the negative impact on QoL is associated with higher scores of depression and anxiety [15]. In these adult studies, the median duration of disease was nine weeks, whereas in this study, it was five weeks. The shorter duration of disease in the study might suggest that patients had not yet developed anxiety and depression disorders. Possibly, as the duration of the disease becomes longer and more chronic, the intense stress it would create could further contribute to 6 Original Article | Dermatol Pract Concept. 2025;15(2):4979 3. Thompson R, Westbury S, Slape D. Paediatrics: how to manage scabies.  Drugs Context. 2021;10:2020-12-13. DOI:10.7573 /dic.2020-12-3. PMID: 33828606; 4. Chorney DB, Detweiler MF, Morris TL, Kuhn BR. The inter- play of sleep disturbance, anxiety, and depression in children.  J Pediatr Psychol. 2008;33(4):339-348. doi:10.1093/jpepsy /jsm105. PMID: 17991689. 5. Savaş Erdoğan S, Falay Gür T, Doğan B. Anxiety and depression in pediatric patients with vitiligo and alopecia areata and their parents: A cross-sectional controlled study. J Cosmet Dermatol. 2021;20(7):2232-2239. DOI: 10.1111/jocd.13807. Epub 2020 Nov 3. PMID: 33089618. 6. Engelman D, Yoshizumi J, Hay RJ, et al. The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies. Br J Dermatol. 2020;183(5):808-820. DOI: 10.1111/bjd.18943. Epub 2020 Mar 29. PMID: 32034956; PMCID: PMC7687112. 7. Kalaycıoğlu S, Kardam F, Tüzün S, Ulusoy M. Türkiye için bir sosyoekonomik statü ölçütü geliştirme yönünde yaklaşım ve denemeler. Toplum ve Hekim, 1998; 13.2:126-137 (In Turkish). Google scholar 8. Balcı DD, Sangün Ö, İnandı T. Cross validation of the Turkish version of children’s dermatology life quality index. J Turk Acad Dermatol. 2007;1.4: 71402a. 9. Erkuran HÖ, Sapmaz ŞY, Herdem A et al. DSM-5 Level 2 Sleep Disorders Scale Validity and Reliability of Turkish Form (Form for Children Aged 11-17 Years and Parent Form for Children Aged 6-17 Years). Noro Psikiyatr Ars. 2018; 4;55(3):256-260. DOI: 10.5152/npa.2017.19324. PMID: 30224873. 10. Gormez V, Kilincaslan A, Ebesutani C, et al. Psychometric Prop- erties of the Parent Version of the Revised Child Anxiety and Depression Scale in a Clinical Sample of Turkish Children and Adolescents. Child Psychiatry Hum Dev. 2017;48(6):922-933. DOI: 10.1007/s10578-017-0716-1. PMID: 28251450. 11. Heukelbach J, Mazigo HD, Ugbomoiko US. Impact of sca- bies in resource-poor communities. Curr Opin Infect Dis. 2013;26(2):127-132. DOI: 10.1097/QCO.0b013e32835e847b. PMID: 23343887. 12. Siddig EE, Hay R. Laboratory-based diagnosis of scabies: a re- view of the current status. Trans R Soc Trop Med Hyg. 2022 ;116(1):4-9. DOI: 10.1093/trstmh/trab049. PMID: 33763705. 13. Boralevi F, Diallo A, Miquel J, et al. Groupe de Recherche Clinique en Dermatologie Pédiatrique. Clinical phenotype of scabies by age. Pediatrics. 2014;133(4):e910-916. DOI: 10.1542 /peds.2013-2880. Epub 2014 Mar 31. PMID: 24685953. 14. Veraldi S, Schianchi R, Nazzaro G. Scabies and nocturnal pru- ritus: preliminary observations in a group of African migrants. J Infect Dev Ctries. 2021;15(6):889-891. DOI: 10.3855/jidc .12905. PMID: 34242201. 15. Koç Yıldırım S, Demirel Öğüt N, Erbağcı E, Öğüt Ç. Scabies Af- fects Quality of Life in Correlation with Depression and Anxiety. Dermatol Pract Concept. 2023;13(2):e2023144. DOI: 10.5826 /dpc.1302a144. Epub ahead of print. PMID: 37196304. 16. Seetan K, Almu’atasim Khamees, BA, Alrababah HM et al. Sca- bies is associated with more anxiety, depression, and impaired quality of life: a cross-sectional comparative study.  J Pharm Negat Results.2022; 6314-6320. 17. Karadoğan SK, Ulgen Altay B. Dermatology Quality of Life and Depression, Anxiety, and Stress Scale-42 in Scabies Patients. Der- matol Pract Concept. 2024 Apr 1;14(2):e2024112. doi: 10.5826 /dpc.1402a112. PMID: 38810073; PMCID: PMC11135924. the development of psychiatric disorders. Similarly, another adult study found higher levels of anxiety, depression, and im- paired QoL in scabies patients compared to the control group, with scabies patients tending to have more moderate-to-severe depression [16]. Additionally, another study conducted by Karadoğan et al. in adult scabies patients showed that the more QoL deteriorates, the higher the levels of depression, anxiety and stress [17]. However, what is known regarding anxiety and depression levels in pediatric scabies patients is limited. In this study, despite comparing anxiety and depression levels between scabies-diagnosed children and the control group, we did not find significant differences. This may be because sca- bies diagnosis and treatment may not persist long enough in children to develop diagnoses of anxiety disorders or depres- sive disorders. Another reason for this difference could be that studies conducted with adult scabies cases are descriptive in nature, with no comparison with a control group. Limitations This study has several limitations. One of these is that par- ticipants were assessed using scales rather than undergoing structured psychiatric interviews. Additionally, the SES index we used to calculate socioeconomic status in this study may be more suitable for community surveys and studies with larger sample sizes, which posed a limitation. Conclusions This study is important because it evaluated sleep disorders, anxiety, depression, and QoL in pediatric scabies cases; it found that sleep disorders are common among children di- agnosed with scabies, negatively impacting their QoL com- pared to healthy controls, but an impact on depression and anxiety levels was not observed. The obtained data can be in- terpreted as suggestive that behaviors such as irritability and restlessness arising from sleep disturbances related to pediat- ric scabies cases do not persist long enough or with sufficient severity to predispose to depression and anxiety disorders. We believe that obtaining information about both night and day sleep patterns during dermatological follow-up of children diagnosed with scabies and providing recommenda- tions on sleep hygiene as part of the treatment process may have positive effects on children’s QoL. References 1. Chiriac A, Diaconeasa A, Miulescu R, Chiriac AE, Wollina U. Scabies in infants and children - a narrative review. Eur J Pediatr. 2024;183(6):2527-2536. DOI: 10.1007/s00431-024-05535-1. Epub 2024 Mar 27. PMID: 38536458. 2. Karthikeyan K. Scabies in children. Arch Dis Child Educ Pract Ed. 2007;92(3):ep65-69. DOI: 10.1136/adc.2005.073825. PMID: 17517973. Original Article | Dermatol Pract Concept. 2025;15(2):4979 7