Management of Pediatric Scabies in Italy: Results of a National Survey and Proposals for an Inter-Specialistic Consensus

Recent years have witnessed a global and European resurgence of human scabies, posing a substantial epidemiological burden on the pediatric population. Clinical management in infants and children presents critical challenges, including diagnostic delays and increasing reports of treatment failure, primarily attributable to obsolete or improper single-application regimens of topical permethrin. To evaluate epidemiological perceptions, diagnostic and therapeutic practices, management hurdles, and educational needs among Italian pediatric healthcare professionals concerning pediatric scabies. A nationwide cross-sectional survey was conducted using a 25-item structured online questionnaire (SurveyMonkey platform) distributed to a representative cohort of primary care pediatricians, hospital pediatricians, and pediatric emergency physicians across Italy. A total of 932 healthcare professionals completed the survey (70.06% Primary Care Pediatricians [PCP]; 20.82% Hospital Pediatricians [HP]). Overall, 75.21% of respondents observed a marked increase in scabies cases over the last 3–5 years, with the highest concentration in children aged 2-5 years (52.58%) and primary transmission occurring within household/family clusters (84.55%). The diagnostic approach remains predominantly clinical and anamnestic (76.29%); 83.26% refer patients to dermatologists for confirmation, and 60.94% rely on specialists for treatment decisions. Diagnostic delays were reported by 93.02% of respondents, primarily driven by clinical misdiagnosis with Infantile eczema/atopic dermatitis (73.39%). Topical permethrin 5% remains the overall first-line therapy (70.82%). Increased treatment failures were noted by 36.80% of participants, with 71.31% associating failures with permethrin. Primary determinants of failure were identified as poor treatment adherence (74.36%), improper management of close contacts (58.34%), high drug costs (32.02%), and suspected pharmacological resistance (24.56%). Finally, 98.82% of respondents considered a joint pediatric-dermatological consensus document useful or indispensable. The survey highlights an urgent requirement for updated diagnostic-therapeutic algorithms, optimized integrated healthcare pathways, and coordinated educational interventions to curb recurrences and combat treatment failures in pediatric scabies.