Crusted (Norwegian) scabies in an infant: A case report

@#INTRODUCTION: Norwegian or crusted scabies is a rare and highly contagious form of skin parasitosis caused by Sarcoptes scabiei var. hominis. Individuals maffffinly affected are considered to be immunocompromised such as those on prolonged glucocorticosteroid therapy, with AIDS or organ transplant patients. This disease presents as a hyperkeratotic dermatosis with an acral distribution. CASE REPORT: This is a case of a 2-month-old healthy Filipino male, who was previously managed as a case of miliaria rubra and treated with clobetasol 0.05% – ketoconazole 2% cream for 1 week. The papules and plaques became widespread. Consult with a pediatrician revealed widespread scabies and for which patient was prescribed topical permethrin with no improvement. On examination, patient presented with multiple erythematous papules and plaques with crusts on the face, trunk, extremities, palms and soles. Thickened yellowish plaques were observed on the palms and soles. Both parents also presented with widespread papules most prominent on the flexural areas accompanied by nocturnal pruritus. On dermoscopy, numerous mites and burrows were seen in a “jet with contrail pattern.” Prominent yellowish scales were also noted. Patient was admitted due to fever and superimposed bacterial infection and was given IV oxacillin, paracetamol, 8% precipitated sulfur in a hypoallergenic lotion applied twice daily and sodium fusidate ointment. On the 4th hospital day, the patient was afebrile and the lesions were noted to decrease in both erythema and crusting. Follow-up dermoscopy revealed absence scales, burrows and mites. CONCLUSION: Prolonged, unsupervised use of topical corticosteroids in our case most likely induced an immunocompromised state thus predisposing the patient to develop Norwegian scabies. In countries were cases of Norwegian scabies have been unresponsive to permethrin and when ivermectin is not available, the use of precipitated sulfur may still be the best therapeutic and safest option for infants.

Widespread lichen planus pigmentosus in a 32-year-old Filipino male treated with low dose isotretinoin and topical tacrolimus

@#INTRODUCTION: Lichen Planus Pigmentosus (LPP) is a pigmentary disorder of unknown etiology, presenting with CASE REPORT: We report a case of a 32-year-old healthy male with widespread lichen planus pigmentosus, treated with clobetasol dipropionate 0.05% ointment, tacrolimus 0.1% ointment, and lowdose isotretinoin (0.1 to 0.2 mkd) showing a decrease in the progression and hyperpigmentation of patches and plaques after six months. CONCLUSION: Based on our case and recent studies, low-dose oral isotretinoin, in combination with topical tacrolimus and topical corticosteroids, may show promising outcomes in treating cases of widespread lichen planus pigmentosus.

Impetigo herpetiformis in a 33-year-old Filipino female

@#Introduction: Impetigo herpetiformis is a rare pustular disorder that affects pregnant women. It is also otherwise termed as “pustular psoriasis of pregnancy”, owing to the fact that the pustules are sterile and are not associated with a viral etiology. The classic lesions are erythematous patches or plaques with margins studded with subcorneal pustules spreading centrifugally. A cardinal feature of this disorder is the rapid resolution of lesions after delivery. Case Summary: This is a case report of a 33-year-old female, gravida 3, para 2 (2-0-0-2) at 36 weeks age of gestation who presented with one week history of multiple well defined irregularly shaped erythematous annular patches and plaques with marginal pustules on the trunk and extremities. The lesions began on the trunk spreading centrifugally, sparing the face, palms, soles and mucus membrane. Biopsy showed scale crust in the stratum corneum, the epidermis showed acanthosis, spongiosis and neutrophilic microabscesses with focal vacuolar alteration and small sub-epidermal nests on the basal cell layer. The dermis revealed dilated blood vessels and mild superficial perivascular lymphocytic infiltrates. Patient was given Prednisone and Cetirizine with noted resolution of lesions. Conclusion: Recurrences of impetigo herpetiformis in subsequent pregnancies are common with earlier onset in gestation and are characteristically more severe. The complications are placental insufficiency, stillbirth or neonatal death. Early detection is of utmost importance. Management must be multidisciplinary involving a dermatologist, obstetrician and pediatrician.

Widespread hemorrhagic varicella in 2 cases of HIV-AIDS

@#INTRODUCTION: Varicella or commonly known as chicken pox is caused by varicella-zoster virus (VZV) that is usually seen as a vesicular eruption in children. It is a highly contagious infection and is the result of exogenous primary infection of a susceptible individual. Immunocompromised individuals have impaired cell-mediated immunity and are prone to develop severe disease. They may have atypical presentations and lesions may sometimes appear hemorrhagic. CASE REPORT: We report two separate cases of HIV-AIDS patients presenting with erythematous umbilicated papules in which the initial clinical impression was molluscum contagiosum. Skin punch biopsy was done and revealed hemorrhagic varicella. Patients were started on intravenous acyclovir with noted remarkable improvement. CONCLUSION: This case report highlights the clinical and histopathologic features of hemorrhagic varicella. A skin biopsy is mandatory to establish the correct diagnosis and to initiate proper treatment.