Rare Form of Crusted Scabies in Diabetes: A Case Report

Crusted scabies is an uncommon manifestation of parasitic infection caused by Sarcoptes scabiei var. hominis. This variant of scabies is seen in various immunocompromised states. Uncontrolled diabetes is an immunocompromised state which is characterized by increased incidence of various infections, and rarely, may be associated with this rare crusted scabies, which may pose a real diagnostic challenge. A high index of suspicion is required for timely and correct diagnosis in the best interest of the patient and the public health point of view to prevent the spread of this highly contagious infestation.

Éxito terapéutico con esquema de ivermectina oral en sarna costrosa / Therapeutic success with oral ivermectin regimen in crusted scabies

Se expone el caso de una paciente obesa inmunodeprimida que presentó una sarna costrosa. Luego de la sospecha clínica se confirmó el diagnóstico mediante acarotest. La paciente sufrió algunas complicaciones asociadas a su condición general, como sobreinfección de sus lesiones cutáneas, epistaxis e insuficiencia renal aguda, que fueron tratadas. La sarna costrosa fue tratada con ivermectina oral con dosis de 15 mg (200 ug/kilo de peso ideal según la talla), los días 1, 2, 7, 8 y 15, obteniendo una excelente respuesta terapéutica.

We present the case of an immunosuppressed obese patient who presented with crusted scabies. After clinical suspicion, the diagnosis was confirmed with skin scraping for the diagnosis of scabies. The patient presented some complications associated with her baseline condition, such as superinfection of her skin lesions, epistaxis and acute renal failure, which were treated. Crusted scabies was treated with oral ivermectin with a dose of 15 mg (200 ug/kg of ideal weight according to height), on days 1,2,7,8 and 15, obtaining an excellent therapeutic response.

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.

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.

Investigation, prevention and control of a healthcare-associated infection outbreak due to Norwegian scabies / 中国感染控制杂志

Objective To understand the epidemiological characteristics of a healthcare-associated infection(HAI)outbreak due to Norwegian scabies in a hospital,and provide basis for clinical prevention and control of HAI.Methods Through epidemiological investigation,all suspected patients and close contacts were investigated and traced,three dimensional distribution of patients was described,a series of effective comprehensive prevention and control measures were formulated and implemented.Results A total of 16 cases of Norwegian scabies infection occurred in November 3-16,2015,the most frequent cases were in November 11(n=5),the onset time of infection was concentrated in November 9-11(n=10),accounting for 62.50%of total cases.Spatial distribution of 16 cases: 12 cases were in general internal medicine department,2 in nursing department,and 2 were relatives of employees.Population distribution: patients aged 50-59(n=7),female(n=13),and nursing staff(n=9).After taking comprehensive prevention and control measures and medication treatment,16 infected persons were all cured,the cure rate was 100%,there was no new cases occurred in the hospital,epidemic was under control.Conclusion Norwegian scabies is highly contagious,it can cause epidemic in local area.In order to avoid spread of scabies infection in hospital,health care workers should strengthen the diagnosis and precaution level of the disease.

An outbreak and treatment of Norwegian scabies occurred in a hospital / 中国感染控制杂志

Objective To investigate the causes and treatment measures of an outbreak of Norwegian scabies oc-curred in a hospital.Methods In May 2013,an outbreak of Norwegian scabies among health care workers(HCWs) occurred because of the misdiagnosis of a patient with Norwegian scabies,epidemiological investigation was carried out by healthcare-associated infection(HAI)control department,medical intervention and disinfection and isolation measures were performed.Results A total of 27 HCWs and patients’relatives developed Norwegian scabies.After active medical treatment,patients’condition improved;all appliances used by patients were cleaned and disinfected after being wrapped and sealed with plastic bags for one week.Epidemic trend of infection was under control and no new case was found.Conclusion With highly contagious,Norwegian scabies can be spread in local area,it is neces-sary to improve HCWs’diagnostic ability to this disease and take effective measures to prevent the epidemic once HAI occur.

Tinea Unguium Hidden by Norwegian Scabies / 대한의진균학회지

Norwegian, or crusted scabies, is a fulminant and highly infectious form of scabies in which a large number of Sarcoptes scabiei mites infest the epidermis. This is often seen in the physically or mentally handicapped, immunocompromised, and institutionalized persons. The characteristic skin lesions in this form are gross scaling and hyperkeratotic plaques with erythematous papules, especially on hands, feet, elbow, and subungual area with varying degrees of pruritus. It may be difficult to differentiate Norwegian scabies from tinea unguium when Norwegian scabies involves nail and subungual area. We report a case of tinea unguium hidden by Norwegian scabies with nail involvement in a 71-year-old patient. This is the first report of such a case in Korea.

An Experience in Successful Infection Control against Norwegian Scabies in Hospital and a Proposal for Hospital Infection Control / 병원감염관리

BACKGROUND: Norwegian scabies is a highly infectious disease characterized by crust formation, different from ordinary scabies, and is caused by Sarcoptes scabiei. After the patient in our case was diagnosed with Norwegian scabies, active measures were taken to prevent its transmission within the hospital. Methods: A 66-year-old female patient was admitted to the general ward of a university hospital on January 23rd, 2008 and 6 days later, she was found to have been infected with Norwegian scabies all over the body. For epidemiological investigation, those who had been in contact with the patient were identified and interviewed. The patient was advised to follow the contact precaution, and linen the patient used was cleaned thoroughly. The surrounding environment was decontaminated by applying surface disinfectant. Preventive cream against the Norwegian scabies was distributed to staff members and patients who had been exposed to the patient, and appointed a dermatologist to educate them on how to use of medicine, what the mechanism of the disease is, what cautions must be taken, and how to write an ex post facto report. RESULTS: After the confirmation of the 1st case, no additional cases have been reported in the hospital during the ensuing 2 months. Therefore, prompt prevention and infection control activities against Norwegian scabies can be thought to have been successful. CONCLUSION: Whena patient with an uncertain skin disease is admitted, pertinent measures must be taken from the moment the patient is admitted and contact precaution should be applied both to the patients and the staff members. When a scabies patient is detected in an institution, the medical staff must enforce as much active preventive measures as possible, and by doing so, there will be a better chance to prevent the outbreak of scabies in the hospital.

Seborrheic Dermatitis-like Norwegian Scabies on a Patient Living in an Eldercare Hospital / 대한피부과학회지

Norwegian scabies is a crusted rash that's caused by a massive infestation with the mite Sarcoptes scabiei. The characteristic skin lesions of this form are gross scaling and hyperkeratotic plaques, and especially on the hands, feet, face, nails and scalp with varying degrees of pruritus. It is often seen in the individuals with human immunodeficiency virus infection, the elderly, immunocompromised patients and institutionalized persons. We report here on a case of Norwegian scabies on an 86-year-old patient who was living in an eldercare hospital, and the patient presented with localized, pruritic, erythematous patches with thick yelolwish crusts on the scalp.

Clinical Study of 27 Cases with Scabies / 대한피부과학회지

BACKGROUND: The incidence of scabies in Korea decreased during the past 20 years. This might have been due to improved personal hygiene and public sanitation. Recently, however, not only the incidence of scabies, but also delayed or missed diagnosis, is likely to increase again. OBJECTIVE: This study was conducted to obtain a better understanding of the clinical characteristics of recent scabietic patients. METHODS: We reviewed the medical records and clinical photographs of 27 outpatients who had been diagnosed with scabies in our department between August 2006 and August 2008. We investigated personal and clinical information, including age, sex, onset, past history and clinical manifestations. RESULTS: Of the 27 patients, 14 (51.9%) were female and 13 (48.1%) were male. Their ages ranged from 4 to 93 years (mean=47.2 years). Over half (51.9%) of the patients had been misdiagnosed at private hospitals. The average time from symptom presentation to diagnosis was 68 days. The most common site of skin lesions was the lower abdomen (77.8%), and the most common primary lesion was erythematous papules (96.3%). Atypical cases of scabies were as follows: 7 nodular scabies (25.9%), 1 crusted scabies (3.7%) and 4 scabies incognito (14.8%). CONCLUSION: Currently, atypical cases of scabies may be increasing and frequently misdiagnosed. We suggest that dermatologists should suspect scabies for any patient who presents with pruritus that is persistent or resistant to treatment.

A Case of Norwegian Scabies in Patient with Acute Myeloid Leukemia Associated Graft-versus-host Disease / 대한피부과학회지

Norwegian scabies is a crusted non-itchy rash caused by massive infestation with the mite Sarcoptes scabiei. It is usually associated with immunosuppression or neurologic impairment, although it has rarely been reported in normal persons. We report a case of Norwegian scabies in 6-year old girl with acute myeloid leukemia associated graft-versus-host disease. The lesion showed pruritic, hyperkeratotic scaly plaques and fissures on the entire body. Application of a mineral oil preparation from hyperkeratotic areas showed numerous scabies mites. Treatment with 10% crotamiton cream for two weeks resulted in marked regression of the skin lesions, but finally she died of sepsis due to deterioration of her systemic conditions.

A Case of Norwegian Scabies Outbreak / 대한피부과학회지

We present a case of Norwegian scabies in a 79-year-old male with chronic obstructive pulmonary disease, which resulted in a ward outbreak of classical scabies. A total of 23 people including nurses, nursing students, physicians, other patients in the same ward and their families were diagnosed with the infestation. Skin scales from the patient revealed numerous scabies mites (21.3/mg) at various stages from egg to adult. The patient had previously suffered from neurodermatitis and xerotic eczema for 5 years. Long-term systemic steroid therapy was considered as a possible cause of Norwegian scabies in this patient. Control of the infestation was achieved by implementing an immediate surveillance system, strict isolation and administration of scabicidal medication.

Sarna costrosa (Noruega): presentación de un caso clínico / Crusted scabies (Norwegian scabies): a case report

Diferentes tipos de sarna han sido descritos con base en sus características clínicas, entre ellos la sarna costrosa (Noruega). Es una manifestación rara y extrema de la escabiosis que se produce principalmente en pacientes inmunosuprimidos. Se presenta el caso de un hombre de 42 años, homosexual, a quien se diagnosticó VIH y que presenta lesiones dérmicas pruriginosas de 4 meses de evolución en tronco y extremidades, constituidas por xerosis, pápulas decapitadas, placas eritematosas, manchas hipercrómicas residuales y múltiples excoriaciones e hiperpigmentación ungueal en ambos pies. Se trató inicialmente como dermatitis psorasiforme que no cedió al tratamiento con esteroides y antipruritico. Se realizó diagnóstico por biopsia que confirmó la sospecha clínica de sarna noruega. Se aplicó un tratamiento con una dosis de ivermectina oral y benzoato de bencilo tópico con remisión en dos días.

Different types of scabies have been described based on their clinical outcome, one of which is the Crusted (Norwegian) type. This is an extreme manifestation of scabies that can be observed mainly among immunosupressed patients. A case ofa 42 year-old homosexual man is described. The patient was diagnosed with HIV, presenting pruritic lesions with a 4 month evolution in trunk and extremities. Lesions included xerosis, decapitated papules, badges with erythema, residual hyperchromic stains, multiple abrasions and ungueal pigmentation in both feet. At the beginning it was treated as apsorasiform dermatitis with steroids and antipruritics without success. Through a biopsy the suspected diagnosis of Crusted (Norwegian) scabies was confirmed. The patient was treated with a dose of oral ivermectin and topical benzyl benzoate and showed remission after two days.

A Case of Norwegian Scabies in a Patient with Pemphigus Foliaceus / 대한피부과학회지

Norwegian scabies can be defined as a generalized, severe scabies infestation which usually affects immunocompromised patients. The diagnosis is commonly missed, and can lead to mismanagement. We describe a patient with Norwegian scabies affecting the whole body. The patient had suffered with pemphigus foliaceus for several years and had an immunosuppressed status due to long-term use of oral corticosteroids. He was admitted to our hospital. At first, we made a diagnosis of exfoliative dermatitis secondary to pemphigus foliaceus. However, no improvement of the condition was seen after an increased dosage of oral corticosteroids, azathioprine, and mycophenolate mofetil. We then identified adult scabietic mites, eggs and scybala upon microscopic examination of skin scales. He was treated with an application of gamma benzene hexachloride cream. We recommend that the diagnosis of scabies be considered in immunocompromised patients with thick skin scales and associated night pruritus.

A Case of Norwegian Scabies in a Patient with Down's Syndrome / 대한피부과학회지

Norwegian, or crusted scabies, is a fulminant and highly infectious form of scabies in which a large number of Sarcoptes scabiei mites infest the epidermis. This is often seen in senile or mentally retarded patients with poor cutaneous sensation, in subjects with severe systemic disease, or immunosuppressed patients. This form of scabies differs from ordinary scabies due to the hyperkeratotic, scaly, and crusted aspect of the lesions. We report a case of Norwegian scabies in 14-year-old boy with Down's syndrome. It is the first reported case in Korea.

A Case of Norwegian Scabies Associated with Long-term Use of Systemic and Topical Corticosteroids / 대한피부과학회지

Norwegian scabies is a rare clinical variant of human infestation with Sarcoptes scabiei, distinguished from the common form of scabies by the presence of remarkable hyperkeratotic scaly crusted skin lesions. It is often seen in the physically or mentally handicapped, immunocompromised, and institutionalized persons. We report a case of Norwegian scabies occuring in a 71-year-old man with pulmonary tuberculosis. He had been treated with systemic and topical corticosteroids for extensive generalized pruritus since about 8 months before.

Features and Morphologic Differences Between 2 Strains of Sarcoptes Scabiei from a Norwegian Scabies Patient and a Scabietic Dog / 대한피부과학회지

BACKGROUND: Variability becomes evident not only if one compares the strains obtained from 2 different host species (host variability) but also within a single strain infesting an individual animal (individual variability). Third kind of variability is observed occasionally when strains from the same host are compared, but in geographically separated countries (geographical variability). However, morphological differences between 2 strains of Sarcoptes scabiei from human and canine scabies have not been studied well in Korea. OBJECTIVE: We compared morphologic differences between 2 strains of Sarcoptes scabiei from a Norwegian scabies patient and from a scabietic dog to assess their variabilities. METHODS: Twenty females and 10 deutonymphs of Sarcoptes scabiei from a Norwegian scabies patient and 27 Sarcoptes scabiei from a dog with canine scabies including 10 females, 10 deutonymphs and 7 protonymphs were collected and observed for this study. We measured and examined size of mites, number of squamous dorsal thorns, type of bare area, number and distribution of squamous ventrolateral thorns under the phase contrast and/or light microscopes. RESULTS: In Sarcoptes scabiei from the dog, squamous dorsal thorns and squamous ventrolateral thorns increased in number as they mature from protonymph to female. In Sarcoptes scabiei from the Norwegian scabies patient, however, squamous dorsal thorns increased in number as they mature and only 1-2 squamous ventrolateral thorns were found in a few females. In Sarcoptes scabiei from the dog, all females had type I bare area, but 8 deutonymphs (80%) had type I bare area and 4 protonymphs (57%) had type II bare area predominantly. In Sarcoptes scabiei from the Norwegian scabies patient, 9 females (90%) had type II bare area and 8 deutonymphs (80%) had type II bare area. In Sarcoptes scabiei from the dog, 8 of 10 females and 4 of 10 deutonymphs had more than three pairs of squamous ventrolateral thorns but 16 of 20 females and 10 of 20 deutonymphs from the Norwegian scabies patient did not have neither right nor left squamous ventrolateral thorns. The size of S. scabiei from the dog was bigger than the size of S. scabiei from the Norwegian scabies patient. CONCLUSION: We confirmed that individual variability, host variability, and geographical variability by observing the 2 strains of Sarcoptes scabiei from a Norwegian scabies patient and a scabietic dog. These results will be helpful for the basic references in morphological studies on scabies mites in Korea as well as in making the diagnosis of canine scabies in humans and dogs.

A case of Norwegian scabies / 대한피부과학회지

An atypical form of scabies is crusted or Norwegian sacbies, which is often seen in the physically or mentally handicapped, immunocompromised, and institutionalized persons. The characteristic skin lesions in this form are gross scaling and hyperkeratotic plaque, especially on the hands, feet, scalp, face, and pressure bearing areas with varying degrees of pruritus. We report a case of Norwegian scabies in a 81 year old patient with a chronic obstructive pulmonary disease using systemic steroid.

Norwegian Scabies

A 77-year-old woman with chronic renal failure and malnutrition had thick crusted plaques, erythematous papules and scaly patches on her entire body. The skin scraping and exfoliated skin scales showed the presence of numerous itch mites, Sarcopbes scabiei var horriums 8667 mites were counted from Ig of the collected samples. Twenty six cases a pruritic rash were reported among hospital personnel: mites were recovered from only one. Among other hospitalized patients, 2 cases of scabies were reported. One patient had pruritic papules and burrows on the left upper arm and the other had lesions in the axilla, mites were recovered from both. Subsequent evaluation suggested that they acquired scabies from a contaminated blood pressure monitoring cuff and a clinical thermometer. The contaminated medical instruments are considered to be fomites, a mode of dissemination of mites.

Two Cases of Norwegian Scabies / 대한피부과학회지

Norwegian scabies is a rare clinical variant of human infestation with Sarcoptes sabiei var, hominis, distinguished from the common form of scabies by the presence of remarkable hyperkeratotic scaly crusted skin lesions. We report two cases of Norwegian scabies occuring in a 25-year-old man with merital retardation and in a 9-year-old boy with aplastic anemia, The first case is characterized. by an extensive hyperkeratotic thickening and crusting of the dorsa of hands, knee 8: elbow joints. There is also subungual accumulation of horny rlebris with nail distortion. Histologically, the epidermis shows a mite in straturn comeurn and mild acanthosis in stratum malpighii. Immunoperoxidase for Ig G,M,A is not stained in the clermoepiderrnal junction and capillary wall of upper dermis. The second case shows hyperkeratotic scaly papules and p]aques on the hands, feet, extremities and trunk. 1'he diagnosis vvas confirrned by the demonstration of adults, nymphs, larvas and eggs of Sarcoptes scabiei con the KOH examination of the skin scrapings. hey l3'ords: Norwegian scabies, Mental retardation, Aplastic anemia