Could it be scabies? Primary care clinicians’ experience of diagnosing scabies outbreaks in nursing and residential care homes for the elderly: a qualitative study

Cathie, V, Middleton, J, Lanza, S, Worsdale, M, Nalabanda, A, Walker, S L, Cassell, J A and Ford, E (2017) Could it be scabies? Primary care clinicians’ experience of diagnosing scabies outbreaks in nursing and residential care homes for the elderly: a qualitative study. In: Society for Academic Primary Care South East Conference 2017, Madingley Hall, 26-27 Jan 2017, Cambridge, Uk.

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Scabies is a contagious parasitic skin condition often found in nursing and residential care homes for the elderly (NRC),[1] where dementia is common. Scabies can present differently in older people[2] and diagnostic delays can facilitate outbreaks which require distressing topical mass treatment.[3]


We conducted a qualitative study to explore how Primary Care Clinicians (PCCs) diagnose scabies in NRCs to identify areas where targeted training may improve outcomes. We undertook semi-structured interviews with PCCs from SE England who had treated patients in NRCs in the previous two years. These were recorded, transcribed and thematically analysed.


14 General Practitioners (GPs) and 7 trainee GPs of varying age, gender and experience participated. PCCs reported approaching diagnosis through history and examination of symptomatic residents, often diagnosing scabies after treating for other dermatological conditions. All PCCs expected to see an intense pruritic rash, classic lesions, and burrows in the finger web spaces, and most would only examine other body regions if the patient complained of itching. Many PCCs reported a lack of confidence in diagnosing scabies and advocated more education about scabies in this setting.


A recent prospective study of scabies outbreaks in NRCs found over half of those with scabies had never complained, and signs were mainly found at atypical locations. Dementia was significantly associated with NRC residents having scabies.[4] In contrast our study shows that PCCs’ approach to diagnosing scabies in NRCs is based on “classical” presentation of scabies which may leave signs on other parts of the body overlooked. The impact of dementia on symptoms and the patient’s ability to communicate were not always considered. We recommend training and learning resources to improve PCCs’ skills and confidence to diagnose scabies in NRCs.


1. Mounsey KE, Murray HC, King M, Oprescu F. Retrospective analysis of institutional scabies outbreaks from 1984 to 2013: lessons learned and moving forward. Epidemiol Infect 2016: 1-10.
2. Wilson MM, Philpott CD, Breer WA. Atypical presentation of scabies among nursing home residents. J Gerontol A Biol Sci Med Sci. 2001; 56(7): M424.
3. Hewitt KA, Nalabanda A, Cassell JA. Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England. Epidemiol Infect 2015; 143(7): 1542-51.
4. Walker S, Cassell J, Nalanbanda A, et al. A prospective study of scabies outbreaks in ten residential care facilities for the elderly [meeting abstract]. Brit J Dermatol 2016; 175(S2 Special Issue): 65.

Item Type: Conference or Workshop Item (Speech)
Keywords: Scabies; primary care; outbreak management; diagnosis; qualitative interviews; sarcoptes scabiei; medical acarology
Schools and Departments: Brighton and Sussex Medical School > Primary Care and Public Health
Subjects: R Medicine
R Medicine > R Medicine (General) > R728 Practice of medicine. Medical practice economics
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0643 Communicable diseases and public health
R Medicine > RA Public aspects of medicine > RA0960 Medical centres. Hospitals. Dispensaries. Clinics Including ambulance service, nursing homes, hospices
R Medicine > RL Dermatology > RL0760 Diseases due to parasites
Depositing User: Jo Middleton
Date Deposited: 30 Jan 2017 12:44
Last Modified: 30 Jan 2017 12:44

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