A community-based validation of the International Alliance for the Control of Scabies Consensus Criteria by expert and non-expert examiners in Liberia

Background

The International Alliance for the Control of Scabies (IACS) recently published expert consensus criteria for scabies diagnosis. Formal validation of these criteria is needed to guide implementation. We conducted a study to provide detailed description of the morphology and distribution of scabies lesions as assessed by dermatologists and validate the IACS criteria for diagnosis by both expert and non-expert examiners.

Methods

Participants from a community in Monrovia, Liberia, were independently assessed by two dermatologists and six mid-level healthcare workers. Lesion morphology and distribution were documented based on the dermatologist examination. Diagnoses were classified by IACS criteria and the sensitivity and specificity of MLHW assessments calculated.

Results

Papules were the most common lesions (97.8%). Burrows were found in just under half (46.7%) and dermatoscopy was positive in a minority (13.3%). Scabies lesions were found in all body regions but more than 90% of patients could have been diagnosed by an examination of only the limbs. Severity of itch was associated with lesion number (p=0.003). The sensitivity of MLHWs to detect typical scabies ranged between 69-83% and specificity 70-96%. The sensitivity of MLHWs was higher in more extensive disease (78-94%).

Conclusions

The IACS criteria proved a valid tool for scabies diagnosis. For the purposes of implementation papules and burrows represent truly typical scabies lesions. MLHWs are able to diagnose scabies with a high degree of accuracy, demonstrating they could form a key component in population-level control strategies.