Diagnostic accuracy of dermoscopy versus clinical examination for early scabies detection in resource-limited settings
DOI:
https://doi.org/10.66344/jpad.v36i2.3362Keywords:
Dermoscopy, Diagnostic accuracy, Clinical examination, Resource-limited settings, ScabiesAbstract
Background Scabies has been identified as high-priority neglected tropical disease, significant due to the lack of treatment resources.
Objective To determine and compare the diagnostic accuracy of dermoscopy and standard clinical examination for the early diagnosis of scabies among patients with suspected scabies in resource-limited settings, using microscopy as the reference standard.
Methods 1,774 patients with suspected scabies were enrolled. Participants underwent either dermoscopy or standard clinical examination, with skin scraping microscopy used as the reference standard. Diagnostic performance measures, including sensitivity, specificity, positive and negative predictive values, likelihood ratios, and overall diagnostic accuracy, were calculated. Inter-observer agreement was assessed using Cohen’s kappa coefficient. Subgroup analyses were performed according to age and sex.
Results Among the 866 participants evaluated using dermoscopy, 684 (79.0%) had microscopy-confirmed scabies, compared with 648 of 908 participants (71.3%) evaluated using standard clinical examination (P<.001). Dermoscopy demonstrated superior diagnostic performance, with higher sensitivity (92.3% vs. 81.5%), specificity (88.7% vs. 76.4%), and overall diagnostic accuracy (90.8% vs. 78.9%) than clinical examination (all P<.001). In addition, dermoscopy significantly reduced the time required to establish a diagnosis compared with clinical examination (4.2±1.1 minutes vs. 6.8±1.4 minutes; P<.001).
Conclusion Dermoscopy is significantly superior to standard clinical examination for the early diagnosis of scabies in resource-limited settings. As a result of dermoscopy's superior accuracy, reproducibility and efficiency, the routine amalgamation of dermoscopy into the management of high-risk populations is warranted.
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