Sarna costrosa: revisión sobre aspectos clínicos de una ectoparasitosis desatendida y de presentación infrecuente / Crusty scabies: review of the clinical aspects of a neglected and infrequent ectoparasitosis

En esta revisión de la literatura se describen aspectos epidemiológicos, fisiopatológicos, clínicos y terapéuticos sobre una presentación atípica y grave de escabiosis, la sarna costrosa o noruega. Esta presentación de escabiosis destaca por afectar principalmente a personas con condiciones de inmunodepresión o sociales que las hacen susceptibles de una alta carga parasitaria, además se asocia a un peor pronóstico y a riesgo de complicaciones. Desde el punto de vista terapéutico, sus estrategias difieren del manejo de la escabiosis clásica.(AU)

This literature review describes epidemiological, pathophysiological, clinical and therapeutic aspects of an atypical and severe presentation of scabies, Norwegian or crusty scabies. This presentation of scabies stands out because it mainly affects people with immunosuppressive or social conditions that make them susceptibleto a high parasite load, it is also associated with a worse prognosis and risk of complications. From a therapeutic point of view, their strategies differ from the management of classic scabies.(AU)

Digital dermoscopy: a complementary method in the diagnosis of scabies

Abstract Scabies is an ectoparasitosis caused by Sarcoptes scabiei var. hominis, characterized clinically by pruritic lesions in typical locations; the crusted form is a rare manifestation. The diagnosis is usually established based on the clinical picture, but dermoscopy can be an important complementary method, as it allows the observation of a brownish triangular structure with a hang-glider appearance. A case of crusted scabies is reported; the magnification of the images obtained by digital dermoscopy allowed the demonstration of a structure usually observed only with videodermoscopy.

Alternativas diagnósticas de escabiose felina / Diagnostic alternatives of feline scabies

A sarna notoédrica é uma doença altamente pruriginosa, causada pelo ácaro Notoedres cati. O diagnóstico consiste na observação do ácaro no material analisado, sendo o raspado cutâneo o método mais utilizado. Outras técnicas têm surgido como alternativas menos invasivas no diagnóstico de sarnas, sobretudo para demodicose em cães, como a de fita de acetato e o arrancamento de pelos, que vêm se mostrando tão sensíveis quanto o raspado cutâneo no diagnóstico de tal dermatopatia. Desse modo, o objetivo deste estudo foi comparar o raspado cutâneo com dois métodos alternativos para diagnóstico de sarna notoédrica em gatos: fita de acetato e arrancamento de pelo, sendo possível concluir que o método da fita é tão sensível quanto o raspado cutâneo, ambos apresentando 100% de sensibilidade. A técnica de arrancamento de pelo apresentou sensibilidade significativamente menor para o diagnóstico de Notoedres cati, resultado esperado, uma vez que esse parasita habita principalmente porções superficiais da derme. Assim, o método da fita de acetato pode ser utilizado de forma eficaz e segura para o diagnóstico de sarna notoédrica em gatos, além de ser menos estressante aos animais, mais rápido e simples do que o raspado cutâneo.(AU)

Notoedric mange is a highly pruritic disease caused by the Notoedres cati mite. The diagnosis consists of the observation of the mite in the material analyzed, skin scrapings is the most used method. Other techniques have emerged as less invasive alternatives in the diagnosis of mange, especially for demodicosis in dogs, such as acetate tape and hair removal, which have shown to be as sensitive as skin scrapings in the diagnosis of such dermatopathy. Thus, the objective of this study was to compare skin scaling with two alternative methods for the diagnosis of notohedral scabies in cats: acetate tape and hair collection, and it is possible to conclude that the acetate tape method is as sensitive as skin scraping, both presenting 100% sensitivity. The hair pulling technique showed significantly lower sensitivity for the diagnosis of Notoedres cati, an expected result, since this parasite inhabits mainly superficial portions of the dermis. Thus, the tape method can be used effectively and safely for the diagnosis of notodroid mange in cats, as well as being less stressful to animals, faster and simpler than skin scraping.(AU)

Escabiasis costrosa imitando una acrodermatitis continua de Hallopeau / Crusted scabies mimicking an acrodermatitis continua of Hallopeau

Resumen Introducción: La escabiasis costrosa (EC) es una variante poco común de sarcoptiosis clásica, altamente contagiosa. Las lesiones poseen una elevada concentración del ácaro Sarcoptes scabiei var hominis, lo que conlleva a un cuadro clínico más extenso que en la escabiasis clásica. Se observa principalmente en pacientes con algún tipo de inmunocompromiso y se relaciona con el síndrome de Down. Caso clínico: Se describe una paciente pediátrica con síndrome de Down quien presentó placas escamosas que afectaron la porción distal de los dedos, asociadas con distrofia ungueal e hiperqueratosis subungueal, por lo que se consideró acrodermatitis continua de Hallopeau como diagnóstico diferencial. Se realizó una biopsia tipo punch con lo que se llegó al diagnóstico de EC. La paciente recibió tratamiento sistémico con ivermectina vía oral y tratamiento tópico con crema hidratante y desonida al 0.1%. Mostró mejoría clínica notoria dos semanas después de finalizar el tratamiento. Conclusiones: La EC es una variante prevalente en pacientes inmunocomprometidos y con síndrome de Down que fácilmente puede confundirse con patologías inflamatorias con alteración de la queratinización epidérmica. Este caso se considera una presentación atípica debido a la afección localizada en los dedos de las manos asociada con distrofia ungueal. El estudio histopatológico fue necesario para realizar el diagnóstico y descartar diagnósticos diferenciales.

Abstract Background: Crusted scabies (CS) is an uncommon, highly contagious, variant of classic scabies. Elevated concentrations of the mite Sarcoptes scabiei var. hominis are found in the skin lesions, which lead to a more exaggerated clinical picture than in classic scabies. This disease is mainly observed in patients with any kind of immunosuppression and relates to Down syndrome. Case report: A pediatric female patient with Down syndrome, who presented a crusty white plaque associated with nail dystrophy and subungual hyperkeratosis affecting the distal portion of the fingers is described. Because of these findings, the diagnosis of acrodermatitis continua of Hallopeau was considered. A punch biopsy was performed, attaining the diagnosis of CS. She received systemic treatment with oral ivermectin, topical treatment with emollient cream and desonide 0.1%. Notorious clinical improvement was observed two weeks after finalizing treatment. Conclusions: CS is variant of scabies prevalent in immunocompromised patients and Down syndrome that can be easily confused with inflammatory pathologies with abnormal epidermal keratinization. This case is considered as an atypical presentation of the disease because of local affection of the fingers and nail dystrophy. The histopathological study was necessary to obtain the diagnosis and rule out differential diagnosis.

Escabiosis: lesiones pruriginosas altamente contagiosas / Scabies: highly contagious pruritic lesions

La escabiosis es una infestación producida por Sarcoptes scabiei, caracterizada por lesiones generalizadas pruriginosas. El diagnóstico es eminentemente clínico. Síntomas compatibles en varios miembros de la misma familia se consideran diagnósticos. El tratamiento consiste en la aplicación de Permetrina al 5% en la superficie cutánea.

Scabies is an infestation produced by Sarcoptes scabiei. Itchy generalized lesions characterized this pathology. The diagnosis is clinical. Compatible symptons presented in some members of the same family are considered diagnostic. The treatment is based in the application of Permetrine 5% in all the cutaneous area.

Norwegian scabies in a patient treated with Tripterygium glycoside for rheumatoid arthritis

Abstract: We report an 80-year-old male patient with severe rheumatoid arthritis who was treated with tripterygium glycoside, an immunosuppressive agent made from the extract of a Chinese medicinal herb called Tripterygium wilfordii Hook F. The patient had no apparent skin lesions before the treatment, but he developed aggressive hyperkeratotic lesions with rapid progression after using tripterygium glycoside. He was repeatedly diagnosed with eczema, but treatment failed to achieve efficacy. Interestingly, a microscopic examination of the lesions revealed numerous scabies mites and eggs. Thus, we confirmed the diagnosis of Norwegian scabies infection. Treated with crotamiton 10% cream and 10% sulfur ointment for one month, the patient's clinical symptoms disappeared.

Crusted scabies due to indiscriminate use of glucocorticoid therapy in infant

Abstract Crusted or Norwegian scabies is a parasitic infectious disease caused by Sarcoptes scabiei var. hominis that mainly affects immunocompromised individuals and those with neurological patients. We report a case of crusted scabies in a 4-month-old infant who had been treated erroneously for atopic dermatitis with high doses of corticosteroids. This initial misdiagnosis associated with the abusive use of corticosteroid facilitated the evolution of scabies to crusted scabies and its main complications of secondary infection and sepsis.

Serie parasitosis en dermatología: escabiosis / Series parasitosis in dermatology: scabies

La escabiosis es una ectoparasitosis pruriginosa producida por el ácaro Sarcoptes scabiei, variedad hominis, específica del ser humano. Si bien su distribución es universal, con frecuencia es subdiagnosticada por asociarla únicamente a hacinamiento y malos hábitos de higiene. Se transmite por contacto directo con una persona afectada o a través de fómites, por lo que es muy común el contagio de los convivientes. Presentamos un caso de escabiosis en una paciente anciana evaluada por prurito generalizado. (AU)

Scabies is a human specific pruritic ectoparasitosis produced by the mite Sarcoptes scabiei var. hominis. Although it has a worldwide distribution, it is often underdiagnosed because it is only associated with overcrowding and poor hygiene. It is transmitted by a direct contact with an affected person or through fomites. The transmission to cohabitants is very common. We present a case of scabies in an elderly patient with generalized pruritus. (AU)

Sarna costrosa / Crusted scabies

La sarna costrosa o noruega es una variedad poco frecuente de escabiosis, caracterizada por un elevado número de parásitos, alta contagiosidad y defectuosa respuesta inmune del huésped. Clínicamente se presenta con múltiples placas hiperqueratósicas fisuradas en sitios habitualmente respetados por la sarna común, acompañada de prurito leve, moderadoo intenso. Presentamos un paciente de sexo masculino de 20 años de edad, con síndrome de Down y diagnóstico de sarna noruega, con excelente respuesta al tratamiento con ivermectina oral.

Crusted or Norwegian scabies is a rare variety of scabies, characterized by a large numberof parasites, high infectivity, and a defective host response. Clinically, it presents withmultiple fissured hyperkeratotic plaques usually on sites unaffected by common scabies,associated with mild, moderate or severe itching. We present a 20 year- old male patientwith Down syndrome and diagnosis of Norwegian scabies who had excellent response tooral ivermectin.

Sarna sarcóptica: comunicación de un brote en un grupo familiar y su mascota / Sarcoptic mange: report of an outbreak in a family and their pet

Scabies caused by the genus Sarcoptes scabiei var canis is a prevalent infection in dogs and affects abandoned, malnourished and overcrowded animals, causing hair loss and an intensely pruritic crusting dermatitis. In humans the manifestation is a self-limiting pruritic dermatitis, but persistent cases are described. An outbreak of sarcoptic mange is reported in a family group (seven people, including a 5 month infant and his mother). The infective source was their own house dog who was taken from the street. The diagnosis was confirmed by the detection of mites and eggs in the acarotest of the dog and mites of S. scabei in the infant. Sarcoptic mange should be suspected in individuals with allergic dermatitis who have contact with dogs. Treatment in humans is usually symptomatic and may need miticides if the infection persists. The control of the disease requires an appropriate pet treatment.

La sarna producida por el género Sarcoptes scabiei var canis, infección prevalente en perros y de alto potencial zoonótico, afecta a animales abandonados, desnutridos y hacinados y causa alopecia y una dermatitis costrosa intensamente pruriginosa. En el ser humano produce una dermatitis pruriginosa generalmente autolimitada, pero se describen casos persistentes. Se reporta un brote de sarna sarcóptica en un grupo familiar (siete personas, incluidas una lactante y su madre) cuya fuente de infección fue su mascota canina recogida de la calle. El diagnóstico fue confirmado por visualización en el ácarotest de ácaros y huevos en el perro y ácaros de S. scabiei en la lactante. La sarna sarcóptica debe sospecharse en casos de dermatitis alérgica en personas con contacto con perros. El tratamiento en el humano, habitualmente sintomático, puede necesitar acaricidas si el cuadro persiste. El control de la enfermedad requiere el adecuado tratamiento de la mascota.

Case for diagnosis / Caso para diagnostico

Human scabies is an intensely pruritic skin infestation caused by Sarcoptes scabiei var. hominis. Crusted scabies (previously known as Norwegian scabies) is a rare form, very contagious and transmitted by direct contact with the skin. Despite being readily treatable, a delayed diagnosis often leads to widespread infestation of contacts, and therefore difficult to restrain. This case concerns a patient where dermoscopy (with scabetic burrows and a visible hand-glider structure), together with direct microscopic examination, allowed a prompt diagnosis, thereby reinforcing the increasing importance of this technique in daily practice.

A escabiose ou sarna humana é uma infestação cutânea intensamente pruriginosa causada por Sarcoptes scabiei var hominis. A sarna crostosa (previamente conhecida como sarna norueguesa) é uma forma rara, muito contagiosa e transmitida pelo contacto direto com a pele. Apesar de eficazmente tratável, um atraso no diagnóstico leva muitas vezes ao contágio e infestação dos contactos, o que dificulta a contenção dos surtos. Apresentamos o caso de um doente onde os achados dermatoscópicos (sulcos escabióticos e estruturas em asa delta), confirmados pelo exame parasitológico direto, permitiram um rápido diagnóstico, reforçando o papel crescente que esta técnica assume na prática clínica.

La gale humaine : profil sociodemographique; distribution lesionnelle et types de lesions

Introduction : La gale humaine est une ectoparasitose due a Sarcoptes scabiei; parasite humain obligatoire. Son diagnostic est essentiellement clinique. Plusieurs auteurs ont recemment decrit sa recrudescence. Ainsi avons-nous voulu etablir un profil socio-demographique; ressortir la distribution lesionnelle et le type de lesions de la scabiose rencontree au cours de nos consultations de Dermatologie a Yaounde (Cameroun). Methodologie : Nous avons mene une etude descriptive et analytique a Yaounde pendant 12 mois (Octobre 2011 a Septembre 2012). Les patients avec un diagnostic de gale humaine pose durant la consultation initiale etaient inclus dans cette etude ouverte au tout venant. Les donnees recoltees prospectivement etaient saisies et analysees sous le logiciel Epi infos version 3.5.3. Resultats : 255 patients etaient retenus dont 158 (62) de sexe masculin et 97 (38) de sexe feminin. L'age variait de 0 a 80 ans avec une mediane de 18; 151 (59.2) etaient contamines par un proche ; 176 (69) signalaient une notion de contage et on notait 42 cas (16;5) de recidive. Une a huit personnes dans l'entourage avait un prurit. Les lesions siegeaient aux plis sous fessiers (71;8); aux poignets (70;2); aux plis inter fessiers (56;5). Les points crouteux (82;4); les papules (69;8) et les papulo-vesicules (68;6) etaient observes. Conclusion : La scabiose reste d'actualite et sa tendance a la propension necessite une sensibilisation aussi bien des populations que des praticiens au diagnostic precoce et a la prise en charge dans un bref delai

Norwegian scabies mimicking rupioid psoriasis / Sarna norueguesa mimetizando psoríase rupioide

Norwegian scabies is a highly contagious skin infestation caused by an ectoparasite, Scarcoptes scabiei var. Hominis, which mainly affects immunosuppressed individuals. Clinically, it may simulate various dermatoses such as psoriasis, Darier's disease, seborrheic dermatitis, among others. This is a case report of a 33-year-old woman, immunocompetent, diagnosed with generalized anxiety disorder (cancer phobia), who had erythematous, well-defined plaques, covered with rupioid crusts, on her neck, axillary folds, breast, periumbilical region, groin area, besides upper back and elbows, mimicking an extremely rare variant of psoriasis, denominated rupioid psoriasis.

A sarna norueguesa é uma infestação cutânea altamente contagiosa causada pelo ectoparasita Sarcoptes scabiei var. hominis, que atinge principalmente indivíduos imunossuprimidos. Clinicamente, pode simular várias dermatoses, tais como psoríase, doença de Darier, dermatite seborréica, entre outras. O artigo relata o caso de uma mulher de 33 anos, imunocompetente, porém com diagnóstico de transtorno de ansiedade generalizada e cancerofobia, que apresentava placas bem delimitadas, sobre base eritematosa, recobertas por crostas rupioides, nas regiões cervical, axilar, mamária, umbilical, inguinal, além de dorso superior e cotovelos, mimetizando uma variante extremamente rara de psoríase, denominada psoríase rupioide.

Ectoparasitosis de importancia en Chile: Epidemiología y terapia / Ectoparasitosis of clinical importance in Chile

Several parasitic diseases affect the skin and appendages in humans, the most common are head lice and scabies. Both diseases have worldwide distribution with geographical variations. In Chile, the reported prevalence of head lice is 20-25 percent and of scabies 1-5 percent. Other ectoparasites include fleas and mite, causing transient parasitosis related to human and animal contact. These parasites are associated with various factors such as poor personal hygiene, promiscuity, long hair, crowding, and sharing of combs, among others. Various effective pharmacological therapies are available, which base on several active compounds. Important therapeutic options include topical treatments with pyrethroids, lindane, crotamiton, and malathion as well as oral medications such as ivermectin, which is used in case of drug intolerance, poor treatment response, infections with multiple parasites or concomitant bacterial infections. For some drugs, resistance has been reported in patients received multiple dosis.

Existen varias enfermedades parasitarias capaces de comprometer piel y fanéreos en el humano, siendo los más frecuentes la pediculosis y la escabiosis. Ambas enfermedades tienen distribución mundial variable según la localidad. En Chile, se describe una prevalencia de pediculosis capitis cercana a 20-25 por ciento y de escabiosis, entre 1 y 5 por ciento. Otras ectoparasitosis son la pulicosis y la acarosis, parasitosis transitorias relacionadas al contacto humano y animal. Estos agentes se asocian a diversos factores entre los que se encuentran escasa higiene personal, promiscuidad, uso de cabello largo, hacinamiento, intercambio de peines, entre otros. Las terapias farmacológicas disponibles son variadas y eficaces. Hay diversos compuestos activos entre los que destacan tratamientos tópicos como derivados piretroides, lindano, crotamitón y malatión; y medicamentos orales como ivermectina, utilizada en casos de mala tolerancia, escasa respuesta a tratamiento tópico, infestación múltiple o infección bacteriana concomitante. Se ha descrito resistencia a algunos compuestos en pacientes que han recibido múltiples dosis.

Sarna costrosa / Crusted scabies

La sarna costrosa es una forma infrecuente y contagiosa de escabiosis que se caracteriza por la infestación masiva de ácaros en la superficie de la piel. Muy raras veces se ha descrito esta enfermedad en la población general, por lo general asociada a estados de inmunosupresión o trastornos genéticos con alguna inmunodeficiencia como base. Se describe el caso de dos pacientes con sarna costrosa, el primero correspondiente a una mujer portadora de infección por HTLV-1 y el segundo a una paciente con Síndrome Down.

Crusted scabies is a rare and contagious form of scabies characterized by the massive infestation of mites on the surface of the skin. It has been very rarely described in general population, usually associated to immunosuppression and genetic disorders with an immunodeficiency base. We describe the case of two patients with crusted scabies, the first, a woman with HTLV-1 and the second a patient with Down syndrome.

Tinea pseudoimbricata por M. gypseum associada à escabiose crostosa / Tinea pseudoimbricata caused by M. gypseum associated to crusted scabies

Tinea pseudoimbricata é relacionada ao T. tonsurans e ao T. rubrum e a escabiose crostosa é uma dermatose altamente contagiosa, ocasionada pela proliferação excessiva do S. scabiei var. hominis. Descrevemos uma paciente com 21 anos, soronegativa para HIV, apresentando ambas doenças dermatológicas. O encontro simultâneo destas dermatoses em pacientes imunocompetentes é muito raro.

Tinea pseudoimbricata is related to T. tonsurans and T. rubrum and crusted scabies is a highly contagious dermatosis caused by excessive proliferation of S. scabiei var. hominis. We described a case of a 21-year-old patient, seronegative for HIV, with both skin diseases. The occurrence of these dermatosis simultaneously in immunocompetent patients is very rare.