10.5826/dpc.1302a144
Introduction: Scabies is a highly contagious disease affects many people worldwide each year and a major public health problem. A small number of studies have shown that scabies causes impairment in the quality of life in adult patients.
Objectives: The aims of this study are to assess the impact of scabies on adult patients quality of life (QoL) and evaluate the relationship between depression and anxiety levels and impairment in life quality.
Methods: This cross-sectional study included adult patients diagnosed with scabies in our dermatology outpatient clinic. The effect of scabies on QoL was evaluated by Dermatology Life Quality Index (DLQI), and the levels of depression and anxiety were evaluated by Beck Depression Scale (BDS) and Beck Anxiety Scale (BAS).
Results: Totally, 85 patients included to the study. QoL of 72.2% of the patients was moderate to extremely large affected. There was a positive correlation between the duration of the disease, the total DLQI score and the severity of the disease impact on QoL (rs= 0.287,  P = 0.01 and rs=0.280, P = 0.008, respectively). A positive correlation was found between the number of treatments received and the total DLQI (rs= 0.223, P = 0.042). There was a positive correlation between BDS and BAS, and total DLQI score (rs=0.448 and P = 0.000; rs=0.456 and P = 0.000, respectively).
Conclusions: Scabies has a moderate to severe effect on QoL. There was a positive correlation between impairment QoL and anxiety and depression scores.
text/xml
2160-9381
2913
en
Çağrı Öğüt
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
anxiety
Scabies Affects Quality of Life in Correlation with Depression and Anxiety
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2023-04-29
2022-10-15
2023-04-29
2023-06-05
e2023144
Dermatol Pract Concept
Introduction: Scabies is a highly contagious disease affects many people worldwide each year and a major public health problem. A small number of studies have shown that scabies causes impairment in the quality of life in adult patients.
Objectives: The aims of this study are to assess the impact of scabies on adult patients quality of life (QoL) and evaluate the relationship between depression and anxiety levels and impairment in life quality.
Methods: This cross-sectional study included adult patients diagnosed with scabies in our dermatology outpatient clinic. The effect of scabies on QoL was evaluated by Dermatology Life Quality Index (DLQI), and the levels of depression and anxiety were evaluated by Beck Depression Scale (BDS) and Beck Anxiety Scale (BAS).
Results: Totally, 85 patients included to the study. QoL of 72.2% of the patients was moderate to extremely large affected. There was a positive correlation between the duration of the disease, the total DLQI score and the severity of the disease impact on QoL (rs= 0.287,  P = 0.01 and rs=0.280, P = 0.008, respectively). A positive correlation was found between the number of treatments received and the total DLQI (rs= 0.223, P = 0.042). There was a positive correlation between BDS and BAS, and total DLQI score (rs=0.448 and P = 0.000; rs=0.456 and P = 0.000, respectively).
Conclusions: Scabies has a moderate to severe effect on QoL. There was a positive correlation between impairment QoL and anxiety and depression scores.
Çağrı Öğüt
2023/04/29
10.5826/dpc.1302a144
e2023144
Department of Psychiatry, Uşak University Training and Research Hospital, Uşak, Turkey
2160-9381
anxiety
en
e2023144
Cole EF, Ojeaga A, Chen S, Swerlick RA. Symptoms of depression and anxiety are associated with poorer functional outcomes in chronic pruritus. J Am Acad Dermatol. 2021;85(3):730-731. doi:10.1016/J.JAAD.2019.06.031
Scabies Affects Quality of Life in Correlation with Depression and Anxiety
https://dpcj.org/index.php/dpc/article/download/2913/2074
          Scabies Affects Quality of Life in Correlation
                  with Depression and Anxiety
               Sema Koç Yıldırım1, Neslihan Demirel Öğüt1, Ece Erbağcı1, Çağrı Öğüt2


1 Department of Dermatology and Venereology, Uşak University Training and Research Hospital, Uşak, Turkey
2 Department of Psychiatry, Uşak University Training and Research Hospital, Uşak, Turkey



Key words: scabies, quality of life, Dermatology Life Quality Index, depression, anxiety
Citation: Koç Yıldırım S, Demirel Öğüt N, Erbağcı E, Öğüt Ç. Scabies Affects Quality of Life in Correlation with Depression and Anxiety.
Dermatol Pract Concept. 2023;13(2):e2023144. DOI: https://doi.org/10.5826/dpc.1302a144
Accepted: November 3, 2022; Published: April 2023
Copyright: ©2023 Koç Yıldırım 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: Dr. Sema Koç Yıldırım; Uşak University Training and Research Hospital, Department of Dermatology
and Venereology, Uşak, Turkey; Tel: +90 536 7371594; E-mail: semakocyildirim@gmail.com




  ABSTRACT             Introduction: Scabies is a highly contagious disease affects many people worldwide each year and a
                       major public health problem. A small number of studies have shown that scabies causes impairment
                       in the quality of life in adult patients.
                       Objectives: The aims of this study are to assess the impact of scabies on adult patients quality of life
                       (QoL) and evaluate the relationship between depression and anxiety levels and impairment in life
                       quality.
                       Methods: This cross-sectional study included adult patients diagnosed with scabies in our dermatol-
                       ogy outpatient clinic. The effect of scabies on QoL was evaluated by Dermatology Life Quality Index
                       (DLQI), and the levels of depression and anxiety were evaluated by Beck Depression Scale (BDS) and
                       Beck Anxiety Scale (BAS).
                       Results: Totally, 85 patients included to the study. QoL of 72.2% of the patients was moderate to
                       extremely large affected. There was a positive correlation between the duration of the disease, the
                       total DLQI score and the severity of the disease impact on QoL (rs= 0.287, P = 0.01 and rs=0.280,
                       P = 0.008, respectively). A positive correlation was found between the number of treatments received
                       and the total DLQI (rs= 0.223, P = 0.042). There was a positive correlation between BDS and BAS, and
                       total DLQI score (rs=0.448 and P = 0.000; rs=0.456 and P = 0.000, respectively).
                       Conclusions: Scabies has a moderate to severe effect on QoL. There was a positive correlation b
                                                                                                                     ­ etween
                       impairment QoL and anxiety and depression scores.




Original Article | Dermatol Pract Concept. 2023;13(2):e2023144                                                                             1
Introduction                                                     Patients
                                                                 Demographic data of patients including age, gender, educa-
Scabies is a contagious skin infestation caused by the mite      tion status, marital status, time between onset of disease and
Sarcoptes scabiei variant hominis. It affects approximately      diagnosis, previous treatment history for scabies, personal
455 million people worldwide each year and is still a ma-        and familial psychiatric disease history were recorded. Ac-
jor public health problem in many resource poor-urban            cording to the age, patients were classified as young adults
and rural regions of developing world [1]. Recently, sca-        (18-44 years), middle-aged persons (45-65 years) and aged
bies outbreaks have been reported in many countries. It was      persons (> 65 years). Educational levels of patients were
also announced as the most common Neglected Tropical             classified according to the Turkish national education system
Diseases (NTDs) with skin manifestation according to the         such as literate, primary school graduate, secondary school
World Health Organization list of NTDs [2,3]. In a study         graduate, high school graduate and university ­graduate. The
from Turkey, it was found nearly 30-fold increase in the         diagnosis of scabies depended on the 2020 International
number of patients with the diagnoses of scabies compar-         ­Alliance for Control of Scabies (IACS) Consensus Criteria
ing 2017 and 2019 and it was also detected that, approxi-        for the Diagnosis of Scabies [10]. Patients diagnosed with
mately 13% of patients were resistant to repetitive topical      ­scabies according to level B (clinical scabies) and level C
treatments [4].                                                  (­suspected scabies) by the dermatology specialist were in-
    Scabies often causes severe itching and patients suffered    cluded to the study. Patients who used 5% permethrin cream
from social stigma, sleep disruption, difficulties in concen-    or lotion with an interval of 7-14 days or 12.5% sulfur
                                                                                                                  ​​
tration and productivity [2,5]. It was reported that scabies     ointment for 3 consecutive days were considered to have re-
was responsible for 0.21% of disability adjusted life years      ceived appropriate treatment [11]. Each cycle of these treat-
from all conditions studied by Global Burden of Disease          ments was considered a single time treatment. Individuals
2015 worldwide [6]. Therefore, the morbidity of scabies          younger than 18 years of age, being pregnant, having crusted
may be related to both the degree of clinical pathology and      scabies and having personal psychiatric disease history were
emotional aspects of the disease. Further, scabies may re-       not included in the study.
duce the quality of life (QoL) of patients with the increasing      All patients were asked to complete the questionnaires,
incidence and treatment resistance. There are few reports        including DLQI, BDS and BAS.
in the literature evaluating QoL of adult patients with sca-
bies [5,7-9]. To the best of our knowledge, there is no study    Questionnaires
evaluating the relationship between scabies and depression       DLQI is comprised of 10 items focuses on 6 domains in-
and anxiety.                                                     cluding symptoms and feelings, daily activities, leisure,
                                                                 work and school, personal relationships and treatment.
Objectives                                                       The DLQI were scored on a 4-point Likert scale (0, “not
                                                                 at all”; 1, “a little”; 2, “a lot”; 3, “very much”), with the
In our study, we aimed to investigate 1) the effects of the      total score ranging from 0 to 30. The higher scores mean
disease on QoL by Dermatology Life Quality Index (DLQI)          the more QoL impaired. During the analysis, scores were
and to evaluate the depression and anxiety scores through        banded into five categories according to the severity of the
Beck Depression Scale (BDS) and Beck Anxiety Scale (BAS)         disease impact on patient life as follows: 0-1, no effect;
in adult patients diagnosed with scabies 2) the relationship     2-5 small effect; 6-10, moderate effect; 11-20, very large
between the social and demographic characteristics of the        effect and 21-30, extremely large effect. Also, a score of
patients and these measures, and 3) the relationship between     1 or more for each domain was accepted as impairment
DLQI and anxiety and depression scores.                          in that domain. Turkish validity study of DLQI was con-
                                                                 ducted [12].
Methods                                                             BDS is a 21-item self-report inventory. For each symptom
                                                                 category, there are four sentences; the subject endorses one
Study Design                                                     of them according to his/her experience during the previous
This cross-sectional study included patients with scabies        week. This form provides a four-point Likert-type measure-
aged 18 years or older during the period between June            ment. Each item gets progressively increasing points between
2021 and December 2021 in our dermatology outpatient             0-3. A high total score indicates a high level of depression
clinics. Informed consent was obtained from all patients.        severity. The BDI was developed by Beck et al was adapted
The approval of the Institutional Review Board was re-           to the Turkish population by Hisli [13,14].
ceived (IRB approval status [approval date and number:              BAI is a 21-item self-report inventory. The items involve
20.05.2021/602.03.99]).                                          symptoms of anxiety. Subjects are asked how much they



2                                                                    Original Article | Dermatol Pract Concept. 2023;13(2):e2023144
experienced each symptom during the previous week on a                            Table 1. Demographic and social
four-point Likert-type scale of 0–3. Higher total scores in-                            features of patients.
dicate higher levels of anxiety. BAI was developed by Beck
                                                                           Number of patients, N (%)                     85 (100)
et al and adapted to the Turkish population by Ulusoy et
                                                                        Gender, N (%)
al. [15,16].                                                            Female                                          41 (48.2)
                                                                        Male                                            44 (51.8)
Statistical Analysis                                                    Age (year), mean ± SD                        34.07 ± 12.33
The statistical analysis was carried out using IBM SPSS Sta-            Disease duration (weeks), median                      8 (9)
tistics 28.0. Continuous data were given as mean ± standard             (IQR)
deviation (SD) and median ± interquartile range [IQR]. Cat-             Education, N (%)
egorical data were given as percentage. Pearson Chi-Square              • Literate                                       2 (2.4)
                                                                        • Primary school graduate                       21 (24.7)
and Pearson Exact Chi-Square analyzes were performed in
                                                                        • Secondary school graduate                     21 (24.7)
the analysis of the cross tables. Mann-Whitney or indepen-              • High school graduate                          24 (28.2)
dent samples t tests were used for quantitative variables. The          • University graduate                            17 (20)
correlation analyses were performed using Spearman rank                 Number of patients received                        30
correlation coefficient (rs). For statistical significance, P < 0.05    appropriate treatment                           28 (93.3)
was accepted as the criterion.                                          5% Permetrin cream/lotion N (%)                 10 (33.3)
                                                                        12.5 % Sulfur ointment N (%)
                                                                        Number of treatments, N (%)                  18 (21.25 (5.9)
Results                                                                 • single time                                    3 (3.5)
                                                                        • two times                                      4 (4.7)
Demographics                                                            • three times
A total of 85 patients with scabies were included in the study.         • four times
Forty-one (48.2%) of the cases were female and 44 (51.8%)
                                                                       IQ = interquartile range; SD =standard deviation. ‡.
were male. The mean age ± SD of the study population was
34.07 ± 12.33 (17-66) years. According to the age catego-
ries, most of the patients were young adults (76.5%), while                Table 2. Banding of the Dermatology Life
22.1% of the patients were middle-aged and 1.2% were                            Quality Index with the scores.
aged. The median disease duration was 8 weeks (IQR 9).                    Number of
The median duration between the onset of disease symptoms               patients, N (%)           Score            Effect severity
and the time of diagnose was 6 weeks (IQR 4). Thirty of                 1 (1.2)                    0-1        No effect
patients (35.3%) had received at least one of the appropriate           22 (26.5)                  2-5        Small effect
treatment options including 5% permethrin cream or lotion               25 (30.1)                 6-10        Moderate effect
and 12.5% sulfur ointment. Fourteen percent of patients had
                                                                        28 (33.7)                11-20        Very large effect
received one of the treatment options at least two or more
                                                                        7 (8.4)                  21-30        Extremely large effect
times. The medications were prescribed by a dermatologist
to 43.3% of the treated patients and the close contacts of
70% of the treated patients were also offered treatment.               patients. The other domains that had the most impact on
Only two patients had a familial history of psychiatric ill-           patients were ‘work and school’, ‘personal relationships’ and
ness. The demographic and social characteristics of patients           ‘daily activities’, respectively. The impairment of each do-
shown in Table 1.                                                      main was demonstrated in Table 3.
                                                                           There was no statistically significant relationship be-
DLQI                                                                   tween total DLQI and gender, education status, marital sta-
Eighty-three of the patients had completed DLQI. The over-             tus, having appropriate treatment and having any comorbid
all mean DLQI score ± SD was 10.54 ± 6.17 (median 9.00).               disease. The total DLQI score was higher in young adults
According to the severity of the scabies impact on QoL of              and the difference was statistically significant (P = 0.06).
72.2% of the patients was moderate to extremely large af-              A positive correlation was found between the duration of
fected. Banding of DLQI with the scores of the patients was            the disease, the total DLQI score and the effect severity
shown in Table 2. The mean score ranged from 0.98 to 3.55              (rs= 0.287, P = 0.01 and rs=0.280, P = 0.008, respectively).
and the median score ranged from 1 to 3 in the individual              There was also a positive correlation between the num-
domains (Figure 1). The domain with the highest impact on              ber of treatments received and the total DLQI (rs= 0.223,
patients that ‘symptoms and feelings’ was impaired in all              P = 0.042). The time between the onset of complaints and



Original Article | Dermatol Pract Concept. 2023;13(2):e2023144                                                                         3
Figure 1. Mean scores of the patients for each domain.




    Table 3. Impairment of each DLQI domain                      disease duration and the number of treatments were higher
              in patients with scabies.                          in those who were with impairment in the ‘treatment’ do-
                                                                 main (question 10) than those who were not (P = 0.042 and
                                  DLQI          Number of
          Domain                questions     patients, N (%)    P = 0.015, respectively). For other domains, there was no sig-
 1. Symptoms and feelings           1,2           83 (100)       nificant difference in disease duration, time to diagnose and

 2. Daily activities                3,4           55 (66.2)      the number of treatments between those with impairment
                                                                 and those who were not.
 3. Leisure                         5,6           49 (59.0)
 4. Work and school                  7            57 (68.6)
                                                                 BDS and BAS
 5. Personal relationships          8,9           55 (66.2)
                                                                 Seventy-five of patients completed BDS and BAS. The mean
 6. Treatment                       10            46 (55.4)
                                                                 BDS score ± SD was 12.11 ± 9.52 and the mean BAS score
                                                                 ± SD was 8.81 ± 9.45. There was no statistically significant
the diagnosis was not effective on total DLQI score and the      relationship between BDS and BAS with age, gender, edu-
severity of the impact on QoL. The correlations related to       cation status, having appropriate treatment and having any
total DLQI scores and the severity of the disease impact on      comorbid disease. No correlation was found between the du-
life quality were shown in Table 4.                              ration of the disease, time to diagnose, number of treatment,
    There was no difference between the patients with im-        and BDS and BAS (Table 4). There was a positive correlation
pairment and without impairment for each domain in terms         between BDS and BAS with total DLQI score (rs=0.448 and
of gender, age, educational status, presence of any comorbid     P = 0.000; rs=0.456 and P = 0.000, respectively).
disease and having appropriate treatment. When we compare           Also, we have compared the BDS and BAS scores of af-
those with and without impairment in individual domains,         fected patients and non-affected patients for each DLQI do-
the disease duration and the time to diagnosis was longer in     main. Those who have impairment in the domain 2 (daily
those with impairment in ‘daily activities’ (question 3 and 4)   activities) and domain 4 (work and school) had significantly
than those without, and this difference was statistically sig-   higher BDS and BAS scores than those without. The BDS
nificant (P = 0.016 and P = 0.019, respectively). Also, the      scores of those with impairment in the domain 5 (personal



4                                                                    Original Article | Dermatol Pract Concept. 2023;13(2):e2023144
             Table 4. The Spearman rank correlation coefficients (rs) for the total DLQI scores,
                                  DLQI effect severity, BDS and BAS.
                                                  Total DLQI         DLQI severity                BDS                    BAS
                                                  rs        P          rs           P        rs         P         rs           P
 Disease duration                              0.280      0.010       0.287    0.008        0.201   0.084        0.05      0.963
 Time to diagnosis                             0.098      0.378       0.159    0.150        0.122   0.297        0.026     0.824
 Number of treatments                          0.223      0.042       0.203    0.066        0.095   0.417         0.07     0.551

BAS = Beck Anxiety Scale; BDS = Beck Depression Scale; DLQI = Dermatology Life Quality Index.




relationship) and domain 6 (treatment) had higher than               ‘leisure’, ‘work and school’ and ‘daily activities’ was greater
those without. Also, the BAS scores of the patients with im-         in males [9]. On the other hand, in a different study, the au-
pairment in the domain 3 (leisure) were higher than without          thors were not found any relationship between the gender
impairment. These findings were shown in Table 5.                    and education similar to our study [5]. These differences may
                                                                     be related to the fact that the studies were conducted in dif-

Conclusions                                                          ferent geographical regions of the world and sociocultural
                                                                     differences.
To the best of our knowledge, this is the first study to evalu-         In studies, the effect of symptom duration on QoL was
ate the life quality of Turkish patients diagnosed with scabies      not generally mentioned, and only one study reported that
and also the depression and anxiety scores and their relation-       those with a symptom duration of 8 weeks or longer tended
ship between DLQI scores in the literature.                          to have more severe impairment on QoL [8]. In our study,
    In the previous studies that investigated health-related         the median disease duration was 8 weeks and we found a
quality of life, it was found that scabies had a small to mod-       positive correlation between the duration of the disease, the
erate effect on life quality [3,5,7-9]. In our study, it was         total DLQI score and the effect severity.
clearly found that scabies had considerable effect on quality           Recently, scabies outbreaks have been reported in many
of life of patients. According to the DLQI scores, the QoL of        countries [17-20. In a study conducted in distinct geographic
72.2% of the patients was affected moderate to extremely             regions of Turkey, a 7-fold increase was found comparing
large. The mean DLQI ± SD score of patients in our study             2017 and 2018, and a 30-fold increase was found and 2017
was 10.54 ± 6.17. In a study from China it was reported              and 2019 [4]. Moreover, in recent years, treatment resistance
10.09 ± 5.96 similar to our study [5] . In another study, the        of scabies has been remarkable, and this may be a cause of
mean score was reported as 3.1 but it was stated there was           the prolonged disease duration [4,19–23]. In our study, 14%
a positive correlation between the severity of the disease and       of patients had received one of the treatment options at least
the scores and, the mean score of adults with severe scabies         two or more times and we found a positive correlation be-
was 7.8 [9]. In our study, the domains with the most impact          tween the number of treatments received and the total DLQI.
on patients were ‘symptoms and feelings’, ‘work and school’,         It is possible to say that treatment unresponsiveness nega-
‘personal relationships’ and ‘daily activities’, respectively. All   tively affects QoL.
of patients had impairment in the domain of ‘symptoms and               Relationships between some dermatological diseases
feelings’ and the impairment percent of other domains were           such as psoriasis, vitiligo, atopic dermatitis, acne vulgaris,
close to each other. In a study, it was reported that ‘symp-         seborrheic dermatitis, hidradenitis suppurativa and chronic
toms and feelings’, ‘work and school’ and ‘personal relation-        pruritus and depression and anxiety were evaluated in differ-
ships’ had the most impact on patients [5]. In another study,        ent studies [24-28]. However, to the best of our knowledge,
the major domains affected in adults were ‘work’ and ‘feel-          no study has been conducted to evaluate the relationship
ings’ [7]. Our findings were comparable to these results in          between scabies and depression and anxiety. In a study eval-
the literature.                                                      uated the depressiveness and anxiety of psoriasis patients,
    In our study, there was no difference between the gen-           the mean BDS score was calculated as 9.36 ± 1.88 and the
der and educational status, and the DLQI score but the total         mean BAS score was found as 11.36 ± 1.79 [29]. In another
DLQI scores were higher in young adults (P = 0.06) also,             study including the chronic urticaria patients, while the
most of the patients of our study population was the young           mean BDS score was 10.56 ± 7.90, the mean BAS was 14.28
adults (76.5%). In a study, it was reported that ‘feeling of         ± 11.58 [30]. In our study the mean BDS score was 12.11 ±
shame’ significantly more often reported by female adults            9.52 and the mean BAS score was 8.81 ± 9.45. While BDS
as compared with males[8]. In another study, the impact on           scores were comparable to these studies, the BAS scores in



Original Article | Dermatol Pract Concept. 2023;13(2):e2023144                                                                     5
6
                                                                                      Table 5. The comparison of the BDS and BAS scores of patients with and without impairment for each DLQI domain.
                                                                                            Domain 2                            Domain 3                            Domain 4                             Domain 5                       Domain 6
                                                                                                Non-                                Non-                                 Non-                               Non-                           Non-
                                                                                Affected      affected        P      Affected     affected        P      Affected      affected           P   Affected    affected    P      Affected    affected    P
                                                                  BDS score,     14.12 ±       8.31 ±       0.03      13.44 ±      10.33 ±     0.051      14.10 ±       7.96 ±      0.002     13.77 ±      9.08 ±    0.017   13.95 ±      10.00 ±   0.033
                                                                  mean ± SD       9.22          9.06                   9.32         9.49                   9.56          8.56                  9.60         9.10              9.52         9.46
                                                                  BAS score,     10.98 ±       4.48 ±      0.000      10.19 ±       5.6 ±      0.001      9.86 ±        4.91 ±       0.01      9.52 ±      5.96 ±    0.082    9.65 ±      6.67 ±    0.06
                                                                  mean ± SD       9.88          6.85                   9.31         7.09                   9.35          6.05                   9.41        6.77               9.61        7.31

                                                                 BAS = Beck Anxiety Scale; BDS = Beck Depression Scale; DLQI = Dermatology Life Quality Index; SD = standard deviation.




Original Article | Dermatol Pract Concept. 2023;13(2):e2023144
our study were lower. We did not find any correlation be-                 6. Karimkhani C, Colombara D v., Drucker AM, et al. The global
tween the duration of the disease and the number of treat-                   burden of scabies: a cross-sectional analysis from the Global
                                                                             Burden of Disease Study 2015. Lancet Infect Dis. 2017;17(12):
ment with BDS and BAS but we found a positive correlation
                                                                             1247-1254. doi:10.1016/S1473-3099(17)30483-8
between BDS and BAS with total DLQI. Nearly, all of pa-
                                                                          7. Ashok Nair PA, Vora RV, Jivani NB, Gandhi SS. A Study of Clinical
tients with impairment in each DLQI domain had higher                        Profile and Quality of Life in Patients with Scabies at a Rural Ter-
scores of BAS and BDS except for BDS in domain 3 and for                     tiary Care Centre. J Clin Diagn Res. 2016;10(10):WC01-WC05.
BAS in domain 5 and 6. These findings may be due to the                      doi:10.7860/JCDR/2016/20938.8703
chronicity of the pruritus, given the mean disease duration of            8. Worth C, Heukelbach J, Fengler G, Walter B, Liesenfeld O, Feld-
                                                                             meier H. Impaired quality of life in adults and children with sca-
patients in our study. It was demonstrated that chronic pru-
                                                                             bies from an impoverished community in Brazil. Int J Dermatol.
ritus were associated with depression and anxiety [26,31].
                                                                             2012;51(3):275-282. doi:10.1111/J.1365-4632.2011.05017.X
These findings made us think that scabies, which affects QoL              9. Lake SJ, Engelman D, Sokana O, et al. Health-related quality
negatively like other chronic dermatologic diseases, may also                of life impact of scabies in the Solomon Islands. Trans R Soc
have negative effects on depressiveness and anxiety, and may                 Trop Med Hyg. 2022;116(2):148-156. doi:10.1093/TRSTMH
have effects beyond being a contagious skin disease.                         /TRAB096
                                                                         10. Engelman D, Yoshizumi J, Hay RJ, et al. The 2020 International
    The limitations of our study are the relatively small num-
                                                                             Alliance for the Control of Scabies Consensus Criteria for the
ber of patients, lack of a control group, being not grouped
                                                                             Diagnosis of Scabies. Br J Dermatol. 2020;183(5):808-820.
the patients according to the clinical severity of scabies.                  doi:10.1111/BJD.18943
Also, we did not follow up the patients after the treatment              11. Salavastru CM, Chosidow O, Boffa MJ, Janier M, Tiplica GS. Eu-
response and could not compared the DLQI, BDS and BAS                        ropean guideline for the management of scabies. J Eur Acad Der-
before and after treatment.                                                  matol Venereol. 2017;31(8):1248-1253. doi:10.1111/JDV.14351
                                                                         12. Öztürkcan S, Ermertcan AT, Eser E, Turhan Şahin M. Cross
    As a conclusion, scabies is a common dermatological
                                                                             validation of the Turkish version of dermatology life quality
problem in our daily routines and the factors such as the
                                                                             index. Int J Dermatol. 2006;45(11):1300-1307. doi:10.1111
disease duration, the necessity of repeating treatment pro-                  /J.1365-4632.2006.02881.X
tocols, itching severity and contagiousness may complicate               13. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory
the management of the disease. Scabies has a moderate to                     for measuring depression. Arch Gen Psychiatry. 1961;4(6):561-571.
severe impact on patients QoL, and as with chronic skin                      doi:10.1001/ARCHPSYC.1961.01710120031004
                                                                         14. Hisli N. A study on the validity of Beck depression inventory.
diseases, depression and anxiety scores increase as quality
                                                                             J Psychol (Psikoloji Dergisi) . 1988;6:118-122.
of life impairment. In this setting, scabies is an important
                                                                         15. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measur-
health problem and it should be kept in mind that patients                   ing clinical anxiety: psychometric properties. J Consult Clin Psy-
diagnosed with scabies are affected not only clinically but                  chol. 1988;56(6):893-897. doi:10.1037//0022-006X.56.6.893
also emotionally, and they can be consulted to psychiatry                16. Ulusoy M, Hisli-Sahin N, Erkmen H. Turkish version of the Beck
departments when necessary.                                                  Anxiety Inventory: psychometric properties. Journal of cognitive
                                                                             psychotherapy . 1998;12(2):163-undefined.
                                                                         17. Redondo-Bravo L, Fernandez-Martinez B, Gómez-­        Barroso D,
References                                                                   et al. Scabies in Spain? A comprehensive epidemiological
                                                                             picture. PLoS One. 2021;16(11). doi:10.1371/JOURNAL.
 1. Vos T, Abajobir AA, Abbafati C, et al. Global, regional, and             PONE.0258780
    national incidence, prevalence, and years lived with disability      18. Lugović-Mihić L. The increase in Croatia’s scabies incidence:
    for 328 diseases and injuries for 195 countries, 1990-2016: a            How did refugees and traveling contribute? Travel Med Infect
    systematic analysis for the Global Burden of Disease Study               Dis. 2019;29:74. doi:10.1016/J.TMAID.2019.02.002
    2016. Lancet. 2017;390(10100):1211-1259. doi:10.1016/                19. Sunderkötter C, Aebischer A, Neufeld M, et al. Increase of sca-
    S0140-6736(17)32154-2                                                    bies in Germany and development of resistant mites? Evidence
 2. Cox V, Fuller LC, Engelman D, Steer A, Hay RJ. Estimating the            and consequences. J Dtsch Dermatol Ges. 2019;17(1):15-23.
    global burden of scabies: what else do we need? Br J Dermatol.           doi:10.1111/DDG.13706
    2021;184(2):237-242. doi:10.1111/BJD.19170                           20. Turan Ç, Metin N, Utlu Z. Epidemiological Evaluation of Scabies
 3. Collinson S, Timothy J, Zayzay SK, et al. The prevalence of              Cases Encountered in the Last Three Years as a Tertiary Health
    scabies in Monrovia, Liberia: A population-based survey. PLoS            Center. Turkiye Parazitol Derg. 2020;44(2):77-82. doi:10.4274
    Negl Trop Dis. 2020;14(12):e0008943. doi:10.1371/JOURNAL.                /TPD.GALENOS.2020.6796
    PNTD.0008943                                                         21. Khalil S, Abbas O, Kibbi AG, Kurban M. Scabies in the age of
 4. Özden MG, Ertürk K, Kartal SP, et al. An extraordinary out-              increasing drug resistance. PLoS Negl Trop Dis. 2017;11(11).
    break of scabies in Turkey. J Eur Acad Dermatol Venereol.                doi:10.1371/JOURNAL.PNTD.0005920
    2020;34(12):e818-e820. doi:10.1111/JDV.16699                         22. de Sainte Marie B, Mallet S, Gaudy-Marqueste C, et al.
 5. Jin-Gang A, Sheng-Xiang X, Sheng-Bin X, et al. Quality of life of        [Therapeutic failure in scabies: An observational study].
    ­patients with scabies. J Eur Acad Dermatol Venereol. 2010;24(10):       Ann Dermatol Venereol. 2016;143(1):9-15. doi:10.1016/J
     1187-1191. doi:10.1111/J.1468-3083.2010.03618.X                         .ANNDER.2015.10.588




Original Article | Dermatol Pract Concept. 2023;13(2):e2023144                                                                                7
23. Mazzatenta C, Piccolo V, Argenziano G, Bassi A. Is Scabies be-     28. Misery L, Touboul S, Vinçot C, et al. [Stress and seborrheic
    coming less sensitive to permethrin therapy? J Eur Acad Derma-         dermatitis]. Ann Dermatol Venereol. 2007;134(11):833-837.
    tol Venereol. 2021;35(9):e607-e609. doi:10.1111/JDV.17339              doi:10.1016/S0151-9638(07)92826-4
24. Akoglu G, Yildiz I, Karaismailoğlu E, Esme P. Disease severity     29. Taner E, Coşar B, Burhanoǧlu S, Çalikoǧlu E, Önder M, Arikan Z.
    and poor mental health are the main predictors of stigmatiza-          ­Depression and anxiety in patients with Behçet’s disease compared
    tion in patients with hidradenitis suppurativa. Dermatol Ther.          withthatinpatientswithpsoriasis.IntJDermatol.2007;46(11):1118-
    2021;34(3). doi:10.1111/DTH.14910                                       1124. doi:10.1111/J.1365-4632.2007.03247.X
25. Talamonti M, Galluzzo M, Silvaggio D, Lombardo P, Tarta-           30. Engin B, Uguz F, Yilmaz E, Özdemir M, Mevlitoglu I. The lev-
    glia C, Bianchi L. Quality of Life and Psychological Impact in          els of depression, anxiety and quality of life in patients with
    Patients with Atopic Dermatitis. J Clin Med. 2021;10(6):1-9.            chronic idiopathic urticaria. Journal of the European Acad-
    doi:10.3390/JCM10061298                                                 emy of Dermatology and Venereology. 2008;22(1):36-40.
26. Lee J, Suh H, Jung H, Park M, Ahn J. Association between chronic        doi:10.1111/J.1468-3083.2007.02324.X
    pruritus, depression, and insomnia: A cross-sectional study.       31. Cole EF, Ojeaga A, Chen S, Swerlick RA. Symptoms of depres-
    JAAD Int. 2021;3:54-60. doi:10.1016/J.JDIN.2021.02.004                  sion and anxiety are associated with poorer functional outcomes
27. Pietrzak D, Pietrzak A, Krasowska D, et al. Depressiveness,             in chronic pruritus. J Am Acad Dermatol. 2021;85(3):730-731.
    measured with Beck Depression Inventory, in patients with               doi:10.1016/J.JAAD.2019.06.031
    psoriasis. J Affect Disord. 2017;209:229-234. doi:10.1016/J
    .JAD.2016.11.045




8                                                                           Original Article | Dermatol Pract Concept. 2023;13(2):e2023144
