Scabies Outbreak in Pediatric Populations of Bangladesh: A Perspective on Therapeutic Management, Risk Factors, and Public Health Implications.

Background and Aims: Scabies remains a major cause of morbidity among Bangladeshi children, particularly in overcrowded and resource-limited settings. This perspective synthesizes current evidence to contextualize the surge of pediatric scabies outbreaks reported across Bangladesh in 2025. This perspective aimed to map outbreak hotspots, identify key risk determinants, and highlight health system gaps in surveillance and diagnosis, and therapeutic management of scabies. Methods: Evidence was compiled from published literature, national health data, WHO reports, media alerts, interviews with 50 registered dermatologists, and ArcGIS-based visualization of affected regions. Results: Outbreaks were widespread across urban slums, religious school (Madrasa), Rohingya refugee camps, university dormitories, flood-affected districts, rural communities and multiple districts including Cumilla, Barisal, Noakhali, Rajshahi, Sylhet, Khulna, Mymensingh, and Cox's Bazar driven by poverty, overcrowding, poor sanitation, seasonal humidity, and limited access to dermatologic care. Treatment practices reported by surveyed physicians revealed that 5% permethrin cream remains the first-line therapy, while oral ivermectin is increasingly used for severe, recurrent outbreaks, although availability and affordability remain inconsistent across districts. Reinfection rates in institutional settings and the absence of national surveillance systems further complicate control efforts. Conclusion: This perspective emphasizes the urgent need for integrated strategies, including strengthened surveillance, improved treatment access, community-based hygiene interventions, and alignment with WHO's NTD roadmap. Strengthening these components is essential to reduce pediatric morbidity, prevent complications, and enhance Bangladesh's progress toward effective scabies control.