Description des pratiques des médecins généralistes dans le diagnostic et la prise en charge de la gale commune

Abstract

Although there is evidence suggesting an epidemiologic increase of scabies in France, few studies have assessed medical practice in terms of diagnosis and treatment. To describe the management of scabies by general practitioners (GPs). A questionnaire was addressed to the 524GPs of the Doubs department in France regarding the management of cases of scabies diagnosed between January and June 2015. The response rate was 57% (n=299). At least one case of scabies was observed by 89% of GPs in the previous six months and more than three cases were diagnosed by 59% of GPs. The main clinical criterion for diagnosis was the specific localization of pruritus (82%). No diagnostic test was used by 94% of GPs other than except direct parasitological examination, which was used by 6%. A systematic examination by a dermatologist was prescribed by 3% of GPs, by 78% of them in the case of diagnostic doubt, and not at all by 19%, even though 66% of GPs' offices were located under 10kilometers from a dermatologist's office. Ivermectin (IVM) alone was prescribed by 38% of GPs, either as a single dose (22%) or as two repeated doses (16%). Topical treatment alone was prescribed by 2% of GPs and the association of IVM and topical treatment was used by 26%, either as a single dose (19%) or as two repeated doses (7%). All household members and any sexual contacts were systematically treated by 77% of GPs, but 9% did not prescribe any treatment. Decontamination advice was given by 100% of GPs. Recurrence of scabies was observed by 25% of GPs despite systematic treatment (93%) of patients' close contacts. Our study confirms the frequency of scabies in general medicine and the interest of GPs in this evaluation of practice. Our data also demonstrate the heterogeneity of management by GPs and the limitations of/poor compliance with national recommendations on scabies proposed by the Haut conseil de santé publique (Public Health Council) in 2012. Our study emphasizes the critical role of GPs in the management of scabies and the need for specific recommendations concerning their practices.