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The 2020 IACS Consensus Criteria for the Diagnosis of Scabies
February 2020British Journal of Dermatology 183(5)
DOI:10.1111/bjd.18943
Authors:
Daniel Engelman
Murdoch Children's Research Institute
J. Yoshizumi
Roderick Hay
King's College London
Millicent Osti
University of Melbourne
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Citations (31)
References (88)
Figures (5)

Abstract and Figures

Background: Scabies is a common parasitic skin condition that causes considerable
morbidity globally. Clinical and epidemiological research for scabies have been limited by a
lack of standardisation of diagnostic methods. Objectives: We aimed to develop consensus
criteria for the diagnosis of common scabies that could be implemented in a variety of
settings. Methods: Consensus diagnostic criteria were developed through a Delphi study of
international experts. Detailed recommendations were collected from the expert panel to
define the criteria features and guide their implementation. These comments were then
combined with a comprehensive review of available literature and opinion of an expanded
group of international experts to develop detailed, evidence-based definitions and diagnostic
methods. Results: The 2020 IACS Consensus Criteria for the Diagnosis of Scabies include
three levels of diagnostic certainty and eight subcategories. Confirmed Scabies (Level A)
requires direct visualisation of the mite or its products. Clinical Scabies (Level B) and
Suspected Scabies (Level C) rely on clinical assessment of signs and symptoms.
Evidence-based, consensus methods for microscopy, visualisation and clinical symptoms
and signs were developed, along with a media library. Conclusions: The 2020 IACS Criteria
represent a pragmatic, yet robust set of diagnostic features and methods. The criteria may
be implemented in a range of research, public health and clinical settings by selecting the
appropriate diagnostic levels and subcategories. These criteria may provide greater
consistency and standardisation for scabies diagnoses. Validation studies and development
of training materials and development of survey methods are now required.
Direct visualization of a scabies mite. (a) Scabies burrow on the finger web space (arrow),
visible with the naked eye. The V-shaped scale ('wake sign') is visible at the top (arrowhead).
(b) Visualization of the scabies burrow from (a) using dry dermoscopy (magnification 9 10).
The open portion of the 'V' points to the intact entrance of the burrow. The female scabies
mite is seen at the distal end of the burrow as a brown triangular spot (arrowhead). (c)
Videodermoscopy image of a burrow (magnification 9 200). The oval body of the female
scabies mite (circle), its eggs (arrows) and its faecal pellets (arrowheads) are visible. (d) In
vivo reflectance confocal microscopy image (field of view 0Á75 9 0Á75 mm) of the female
mite. The oval body is visible within the epidermis (upper stratum granulosum), along with its
head (arrowhead), anterior legs (arrows) and faecal pellets (asterisks).
Direct visualization of a scabies mite. (a) Scabies burrow on the finger web space (arrow),
visible with the naked eye. The V-shaped scale ('wake sign') is visible at the top (arrowhead).
(b) Visualization of the scabies burrow from (a) using dry dermoscopy (magnification 9 10).
The open portion of the 'V' points to the intact entrance of the burrow. The female scabies
mite is seen at the distal end of the burrow as a brown triangular spot (arrowhead). (c)
Videodermoscopy image of a burrow (magnification 9 200). The oval body of the female
scabies mite (circle), its eggs (arrows) and its faecal pellets (arrowheads) are visible. (d) In
vivo reflectance confocal microscopy image (field of view 0Á75 9 0Á75 mm) of the female
mite. The oval body is visible within the epidermis (upper stratum granulosum), along with its
head (arrowhead), anterior legs (arrows) and faecal pellets (asterisks).
…
Skin examination findings of scabies. (a) Papules over the fingers, finger web spaces and
back of hand of an adult. (b) Papules and vesicles with excoriation on the volar wrist of a
child. (c) Papules, vesicles and pustules with excoriations over the palm and fingers of an
infant. (d) Widespread scabies rash in an infant. Larger nodules are seen on the torso, axilla
and shoulder. (e) Papules over the toes, feet and ankle of an infant. (f) Ulcers, pustules and
crust representing impetiginization (secondary bacterial infection) of scabies lesions on the
legs of a child. (g) Papules and nodules on the scrotum and penis. Lesions are also seen on
the groin and inner thighs. (h) Crusted scabies with thick, yellowish scale of the right hand.
Skin examination findings of scabies. (a) Papules over the fingers, finger web spaces and
back of hand of an adult. (b) Papules and vesicles with excoriation on the volar wrist of a
child. (c) Papules, vesicles and pustules with excoriations over the palm and fingers of an
infant. (d) Widespread scabies rash in an infant. Larger nodules are seen on the torso, axilla
and shoulder. (e) Papules over the toes, feet and ankle of an infant. (f) Ulcers, pustules and
crust representing impetiginization (secondary bacterial infection) of scabies lesions on the
legs of a child. (g) Papules and nodules on the scrotum and penis. Lesions are also seen on
the groin and inner thighs. (h) Crusted scabies with thick, yellowish scale of the right hand.
…
Typical distribution of scabies lesions. (a) Children aged > 2 years and adults. (b) Infants
aged < 2 years.
Typical distribution of scabies lesions. (a) Children aged > 2 years and adults. (b) Infants
aged < 2 years.
…
Definitions for contact history for scabies transmission
Definitions for contact history for scabies transmission
…
Differential diagnoses for scabies
Differential diagnoses for scabies
…
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GUIDELINES BJDBritish Journal of DermatologyThe 2020 International Alliance for the
Control of ScabiesConsensus Criteria for the Diagnosis of ScabiesD. Engelman iD,1,2,3J.
Yoshizumi,4,5R.J. Hay,6M. Osti,1,2G. Micali,7S. Norton,8S. Walton,9F. Boralevi,10C.
Bernigaud,11,12A.C. Bowen,13,14,15A.Y. Chang,16O. Chosidow iD,11G.
Estrada-Chavez,17H. Feldmeier,18N. Ishii,19F. Lacarrubba,7A. Mahe,20T.
Maurer,16,21M.M.A. Mahdi,22,23M.E. Murdoch,24D. Pariser,25P.A. Nair,26W.
Rehmus,27,28L. Romani,1,29D. Tilakaratne,15,30M. Tuicakau,31,32S.L. Walker,33,34K.A.
Wanat,35M.J. Whitfeld,36R.R. Yotsu,37,38A.C. Steer1,2,3and L.C. Fuller
iD39,40CorrespondenceDaniel Engelman.Email: Daniel.Engelman@rch.org.auAccepted for
publication7 February 2020Funding sourcesD.E., A.C.B., L.R. and A.C.S. are supported
byfellowships from the Australian National Healthand Medical Research Council. The
InternationalLeague of Dermatological Societies supported theInternational Alliance for the
Control of Scabies toundertake this work.Conflicts of interestC.B. reports receiving research
support from Bio-derma Laboratoire Dermatologique and CodexialDermatologie. W.R. has
served on advisory boardsfor Cipher, Pfizer, LEO Pharma and Sanofi Gen-zyme in the past
2 years. All of the other authorsdeclare no conflicts.The author affiliations can be found in
theAppendix.DOI 10.1111/bjd.18943SummaryBackground Scabies is a common parasitic
skin condition that causes considerablemorbidity globally. Clinical and epidemiological
research for scabies has beenlimited by a lack of standardization of diagnostic
methods.Objectives To develop consensus criteria for the diagnosis of common scabies
thatcould be implemented in a variety of settings.Methods Consensus diagnostic criteria
were developed through a Delphi studywith international experts. Detailed recommendations
were collected from theexpert panel to define the criteria features and guide their
implementation. Thesecomments were then combined with a comprehensive review of the
available lit-erature and the opinion of an expanded group of international experts to
developdetailed, evidence-based definitions and diagnostic methods.Results The 2020
International Alliance for the Control of Scabies (IACS) Consen-sus Criteria for the Diagnosis
of Scabies include three levels of diagnostic cer-tainty and eight subcategories. Confirmed
scabies (level A) requires directvisualization of the mite or its products. Clinical scabies (level
B) and suspectedscabies (level C) rely on clinical assessment of signs and symptoms.
Evidence-based, consensus methods for microscopy, visualization and clinical
symptomsand signs were developed, along with a media library.Conclusions The 2020 IACS
Criteria represent a pragmatic yet robust set of diagnos-tic features and methods. The
criteria may be implemented in a range ofresearch, public health and clinical settings by
selecting the appropriate diagnosticlevels and subcategories. These criteria may provide
greater consistency and stan-dardization for scabies diagnosis. Validation studies,
development of trainingmaterials and development of survey methods are now
required.What is already known about this topic?•The diagnosis of scabies is limited by the
lack of accurate, objective tests. Micro-scopy of skin scrapings can confirm the diagnosis,
but it is insensitive, invasive andoften impractical.•Diagnosis usually relies on clinical
assessment, although visualization using der-moscopy is becoming increasingly
common.•These diagnostic methods have not been standardized, hampering the
interpretationof findings from clinical research and epidemiological surveys, and the
develop-ment of scabies control strategies.©2020 The Authors. British Journal of
Dermatologypublished by John Wiley & Sons Ltd on behalf of British Association of
DermatologistsBritish Journal of Dermatology (2020) 1This is an open access article under
the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which
permits use anddistribution in any medium, provided the original work is properly cited, the
use is non-commercial and no modifications or adaptations are made.

Citations (31)

References (88)

... Other lesions that may be observed in the course of classic scabies are vesicles (usually
at the start of a burrow), nodules (firm, 0.5 cm in diameter), and weals [21]. Typical scabies
lesions stem from a hypersensitivity response to mite products and are also possibly caused
by temporary excavations of immature mites [17]. ...
... Multiple body surfaces are involved in many cases, but the distributions may differ in
infants, children under 2 years old, and adults. Nevertheless, the regions containing lesions
are roughly symmetrical across the left and right sides of the body [17]. Table 1. ...
... Table 1. Differentiation of scabies subtypes and their localizations in adults, children, and
infants (author's own elaboration based on [17,26,[49][50][51] ...
Sarcoptes Infestation. What Is Already Known, and What Is New about Scabies at the
Beginning of the Third Decade of the 21st Century?
Article
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Jul 2021
Katarzyna Talaga-Ćwiertnia
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Show abstract
... This study is one of the first to use the 2020 International Alliance for the Control of
Scabies (IACS) Criteria for diagnosis of scabies. [18] ...
... Four nurses from Western Province were trained in basic dermatologic clinical
assessment (skin examination and history taking), with particular emphasis on the signs and
symptoms of scabies as per the 2020 IACS Criteria, and clinical features of impetigo, and
how to differentiate these from other skin conditions using clinical criteria, without any
specialised equipment. [18] Nurses were taught to refer any suspected cases of crusted
scabies for further assessment. The training program included interactive tutorials run over a
two-day period conducted by three doctors experienced in scabies and impetigo diagnosis.
...
... Examination of children aged less than two years included the trunk, as distribution of
scabies may be more widespread in this age group. [18,23] For each participant, a nurse
checked for the presence of scabetic lesions and recorded if these were of typical or atypical
appearance for scabies. They also checked for the presence of infected skin lesions
(impetigo). ...
Defining the need for public health control of scabies in Solomon Islands
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Susanna J Lake
Daniel EngelmanOliver SokanaAndrew C. Steer
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Scabies as a part of the World Health Organization roadmap for neglected tropical diseases
2021–2030: what we know and what we need to do for global control
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Dec 2021
Amal A. El-Moamly
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Show abstract
Prospective Surveillance of Primary Healthcare Presentations for Scabies and Bacterial Skin
Infections in Fiji, 2018–2019
Article
May 2021AM J TROP MED HYG
Li Jun Thean
Lucia Romani
Daniel EngelmanAndrew C. Steer
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Scabies in a 4-week-old baby boy, a diagnostic challenge
Article
May 2021Arch Dis Child
Elima Pérez de DiegoItziar Bueno VidánCésar David Herrera MolinaElisa Fernandez Cooke
View
Paediatrics: how to manage scabies
Article
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Russell ThompsonSean WestburyDana Slape
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Development of a rapid scabies immunodiagnostic assay based on transcriptomic analysis
of Sarcoptes scabiei var. nyctereutis
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Nobuhide KidoYasuo Ono
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Prevalence of scabies and impetigo in school-age children in Timor-Leste
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Alexander MatthewsBrandon LeSalvador Amaral
Susana Nery
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Recent advances in understanding and treating scabies
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Margot Whitfeld
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33-Year-Old Male with Itchy, Erythematous Papules on His Trunk
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Background Scabies was added to the WHO Neglected Tropical Diseases portfolio in 2017,
and further understanding of the disease burden is now required. There are no uniformly
accepted test methods or examination procedures for diagnosis, which limits the
interpretation of research and epidemiological findings. The International Alliance for the
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