Case report of crusted scabies, brief review of its pathophysiology and latest data.

Background: Crusted scabies is a rare form of parasitic infection provoked by a massive infestation of the ectoparasite Sarcoptes scabiei varietas hominis on human skin. It is an extremely contagious type of disease and can even lead to a social stigma. In European countries like Greece, many cases remain undiagnosed for long periods, causing extreme distress in the patient's everyday life and social environment. Case Description: Herein, we present a case of an 86-year-old woman with crusted scabies in Greece, who remained undiagnosed for 5 months. Massive hyperkeratotic plaques on the extremities, and face, palmoplantar keratoderma, and numerous small erythematous papules on the torso with extreme itch were the main clinical manifestations of the patient. Dermoscopy revealed the parasite. All necessary decontamination measures were taken by personnel. Treatment was administered and a complete cure of the disease was observed. Conclusions: In this case, the use of dermoscopy has attributed to precise crusted scabies diagnosis and acute pharmacological management of the patient. Early diagnosis of such diseases not only saves patients from lethal secondary infections, but also reduces the risk of a massive scabies outbreak. We also conducted a mini-review, analyzing all recent data concerning crusted scabies macroscopic, dermatoscopic, and histological images. All new information concerning the pathophysiological mechanism of crusted scabies manifestation, updated treatment options, and potential resistance to widely-used treatments are provided.

An unusual adverse effect during crusted scabies treatment.

Crusted scabies is a severe form of scabies infestation caused by the ectoparasite Sarcoptes scabiei. Risk factors include immunosuppression, neuropathies, and psychiatric disorders. Its management poses important challenges due to its contagius nature. Here we present a case or Acute Generalized Exanthematous Pustulosis secondary to Ivermectin therapy in a patient with crusted scabies.

A systematic review of immunosuppressive risk factors and comorbidities associated with the development of crusted scabies.

OBJECTIVES: Crusted scabies (CS, Norwegian scabies) is a severe form of scabies, characterized by hyper-infestation of Sarcoptes scabiei mites. CS is commonly associated with immunosuppression but is also reported in overtly immunocompetent individuals. We reviewed immunosuppressive risk factors and comorbidities associated with CS. METHODS: The National Library of Medicine (PubMed) database was reviewed for patient case reports of CS from January 1998 to July 2023. Two authors screened records for eligibility, extracted data, and one critically appraised the quality of the studies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023466126. RESULTS: A total of 436 records were identified, of which 204 were included for systematic review. From these, 683 CS patients were included. CS impacted both genders equally. Adults (21-59 years) were more commonly affected (45.5%) compared to children (0-20 years, 21%). Corticosteroid use was the most prevalent immunosuppressive risk factor identified (27.7% of all cases). About 10.2% of reports were associated with HIV/AIDS, and 8.5% with HTLV-1 infection. 10.5% of patients were overtly immunocompetent with no known risk factors. Overall, 41 (6.0%) died, many subsequent to secondary bacteremia. CONCLUSION: This study represents the first systematic review undertaken on immunosuppressive risk factors associated with CS. This provides insights into trends of immunosuppression and mechanisms of CS development.

Ungual Scabies: A Case Report and Review of Literature.

Introduction: Nail unit infestation by scabies mites (ungual scabies) is uncommon. It usually presents with distal subungual lesions, leading to recurrent and persistent disease by acting as a reservoir of infection. Periungual involvement in scabies with nail loss is rare and may lead to severe nail damage. Case Presentation: We report a 14-year-old boy on chemotherapy for acute lymphocytic leukemia (ALL) who presented with extensive scaling and crusted plaques of scabies. Nail unit revealed periungual crusted plaques with paronychia and onychomadesis involving five digits. It was associated with partial to complete nail loss. Dermoscopy of periungual crusted plaques showed greyish-white scales with brown dots and globules. A sinuous burrow with a brown-triangular structure was visualized in the web space. KOH mount from skin scrapings showed the scabies mites. Treatment of scabies led to a marked improvement. Conclusion: Though ungual scabies is generally a benign disease, proximal periungual involvement with damage to nail matrix is possible, leading to nail loss. We review manifestations of nail unit scabies reported in literature. Treatment options used and outcomes are also analyzed. The importance of nail-directed therapy in preventing relapses of scabies cannot be undermined.

Norwegian Scabies in a 70-Year-Old Renal Transplant Recipient: A Case Report.

Crusted scabies (CS) is an extremely contagious variant of classical scabies with substantial morbidity and mortality. It is the most prevalent in immunocompromised patients, those with some underlying diseases, and individuals with physical and mental disabilities. Herein, we report a 70-year-old woman who presented with generalized erythema with itchy hyperkeratotic plaques and crusted lesions on her face, hands, between fingers, neck, scalp, abdomen, and legs up to the knees. She was diagnosed with CS and subsequently isolated and treated with ivermectin (200 µg/kg) and 5% permethrin cream. She died a short time after being admitted, and it was due to severe septic shock and cardiac arrest. Immediate isolation and treatment of CS patients is essential to prevent morbidity and mortality. Prompt diagnosis and precise medical management in both patients and healthcare settings is required.

Crusted Hyperkeratotic Scabies: A Case Report.

Crusted scabies is a rare form of classic scabies characterized by severe symptoms, mainly observed in immunosuppressed patients. This disease has been associated with a variety of health problems, such as delayed diagnosis, infection risk, and high mortality, mainly from sepsis. We report the case of a patient with hyperkeratotic scabies in the context of immunosuppression associated with malnutrition and the use of topical corticosteroids. Ivermectin is critical for successfully treating crusted scabies. However, a higher cure rate has been reported with the combination of oral ivermectin and topical permethrin. In our study, we chose to use a plan suitable for grade two scabies, resulting in a subtotal regression of the lesions. Crusted scabies is a highly contagious parasitic cutaneous disease, and there are few reports in the national and international literature. It is necessary to suspect this presentation form in order to establish a timely diagnosis and detect and treat associated comorbidities.

Neonatal Norwegian scabies.

Norwegian scabies is a severe form of scabies usually seen in immunocompromised children and adults. It is rarely reported in the neonatal age group. We present such a case.

A scabies outbreak in an inpatient rehabilitation setting.

BACKGROUND: Scabies is a skin infection transmitted by close person-to-person contact. Crusted scabies is a more severe type which is more contagious. Delayed diagnosis of scabies could lead to an outbreak. METHODS: The outbreak occurred at a 435-bed academic medical center with 76 inpatient rehabilitation beds. The index patient was incarcerated and admitted to our hospital in February 2022. The patient developed crusted scabies after steroids treatment. RESULTS: The patient was treated with oral ivermectin (200 mcg/kg, maximum dose 15 mg) and topical permethrin 5%. All units were followed for 6 weeks since diagnosis of the index patient. A total of 46 healthcare workers (20 nurses and 26 physical therapists) were exposed. Twenty-nine presented symptoms and were treated with ivermectin and permethrin or only ivermectin. No physicians, other patients, or prison guards were affected. There was no secondary household transmission of those exposed healthcare workers. CONCLUSIONS: Scabies is highly contagious in high-risk patients. Early diagnosis and effective infection control are of vital importance.

Exaggerated hyperkeratosis in a nursing home patient.

Scabies, caused by the mite Sarcoptes scabiei var hominis, is a common infestation that presents with intense itching. Crusted scabies, also known as Norwegian scabies, is a severe variant of classic scabies that is characterized by hyperkeratotic lesions and often manifests in immunosuppressed patients. There is both a high parasitic load and high infectivity with this form of scabies because crusted scabies can look similar to many conditions including psoriasis, eczema, and seborrheic dermatitis, diagnosis can be difficult and is based on both clinical findings and microscopic detection of the scabies mite, eggs, or fecal material (scybala). We describe a case of a 64-year-old female patient diagnosed with crusted scabies.

Crusted Scabies, a Neglected Tropical Disease: Case Series and Literature Review.

Crusted scabies is a rare form of scabies that presents with more severe symptoms than those of classic scabies. It is characterized by large crusted lesions, extensive scales, thick hyperkeratosis, and contains a large number of highly contagious itch mites. Crusted scabies is more prevalent in immunocompromised, malnourished, and disabled individuals. This disease has been linked to a variety of health problems, including delayed diagnosis, infection risk, and high mortality, mainly from sepsis, and it has the potential to cause an outbreak due to its hyper-infestation, which makes it highly infectious. This article reports three cases of crusted scabies in North Sulawesi, Indonesia. Recent updates and a comprehensive review of the literature on the disease are also included, emphasizing the critical importance of early diagnosis and effective medical management of patients, which are necessary to prevent the complications and spread in communities.

Oral Albendazole as an Alternative Treatment for Moderate Crusted Scabies Along with 5% Permethrin and 5% Salicylic Acid.

Crusted scabies (CS) is a severe variant of scabies, highly contagious, caused by numerous Sarcoptes scabiei (S. scabiei) infestation. CS is associated with immunosuppressive conditions, like systemic lupus erythematosus (SLE). Various topical and oral scabicidals are used in the treatment of CS, including topical sulfur compounds, benzyl benzoate, crotamiton, lindane, malathion, permethrin, and ivermectin. The treatment of CS does not only need scabicidals, but also keratolytic agents to remove the thick crusts. The severity of CS is classified into three levels and related to the dose of oral ivermectin treatment. When oral ivermectin is not available, oral albendazole can be used as an alternative treatment. A case of CS in a 21-year-old girl with SLE was reported. Physical examination showed multiple lesions in the form erythematous papules, plaques, scales, and hyperkeratotic crusts in almost all parts of the body. The distribution of crusting >30% body surface area, the depth of crusting >10 mm, and there were pyoderma. Sarcoptes scabiei, eggs, and scybala were found on skin scraping. The patient was diagnosed as a moderate CS and treated with occlusive dressings using 5% salicylic acid in vaseline until crusts fell off, 5% permethrin cream three times per week, and 800 mg/day albendazole three consecutive days per week. A clinical and microscopic cure was achieved at day 19 of observation. Albendazole is an antiprotozoal agent with larvicidal effect, therefore it can be used as an alternative treatment of CS when oral ivermectin is unavailable, along with 5% permethrin and 5% salicylic acid.

Crusted scabies in children in France: a series of 20 cases.

To evaluate the risk factors for crusted scabies in children in France. The retrospective multicenter study, conducted in France, of children (aged < 18 years) with profuse and/or crusted scabies confirmed by dermoscopy and/or microscopy. Data were obtained using a standardized questionnaire. We included 20 children. The mean age was 4.5 years, and 70% of the patients were girls. Their medical history revealed a neurological pathology (agenesis of the corpus callosum; n = 1, 5.0%), prematurity (n = 1, 5.0%), Down syndrome (n = 1, 5.0%), atopic dermatitis (n = 2, 10%), and asthma (n = 2, 10.0%). Fifteen (75.0%) children were treated with steroids before being diagnosed with scabies: 12 (60.0%) with topical steroids, one (5.0%) with a systemic steroid, and two (10.0%) with inhaled steroids. One child (5.0%) lived in a precarious environment. The mean duration of pruritus was 3.4 months, and that of the skin lesions was 3.1 months. The most commonly affected areas for crusted scabies were the palms/hands (66.7%) and the armpits (33.3%). Thirteen children (65.0%) were hospitalized, 14 (70.0%) were treated with ivermectin and all received topical treatments; 85.7% were cured within an average of 38 days, but one child had a relapse 3 months later in the form of common scabies.Conclusion: The main risk factor for developing crusted scabies in France was the misdiagnosis and the use of corticosteroids, especially topical forms typically used in "healthy" children. Management of the children was effective and similar to that used in adults. What is Known: • Crusted scabies is an extremely contagious disease which is rarely reported in infancy, especially in healthy children. • The main risk factors include immunosuppression, physical debilitation, and intellectual disability. What is New: • The main risk factor of severe scabies in this study was delayed diagnosis associated with the use of topical or systemic corticosteroids. • The treatment was successful in 85.7% of cases, and 65% of children needed to be hospitalized.

Crusted scabies in AIDS patient, a clinical challenge to be sorted out with a simple bedside test.

Norwegian or crusted scabies is a highly contagious severe variant of scabies described first among leprosy patients in Norway in 1848 by Boeck and Danielsen. Herein, we report a case of crusted scabies in an AIDS patient with large hyperpigmented macules covered with thick crusts present over the axilla, inguinal region, and gluteal region. Treatment started immediately with ivermectin, permethrin, and keratolytics after doing KOH microscopy. Mite population may exceed 1 million/person. Hence, it is highly infectious and can set off epidemics of scabies in home or institutions.

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)

Unusual presentation of crusted scabies with osteolysis in immunocompetent.

BACKGROUND: Crusted scabies results from a failure of the host immune response to control the proliferation of the scabies mite in the skin, with resulting hyperinfestation and a concomitant inflammatory and hyper-keratotic reaction. However, it has also been recognised in people with no evident immunological deficit. CASE HISTORY: We present a case report of apparently immunocompetent 16-year-old female presenting with multiple hyperkeratotic vegetating plaques over limbs, excoriated papules over trunk with minimal itching since 2 years without any positive family history. The microscopic examination of the skin scales with potassium hydroxide demonstrated numerous scabies mites and eggs. Histopathology showed hyperkeratosis with multiple mites in stratum corneum. Numerous mites were seen on biopsy of lesion. X-ray showed osteolysis of distal phalanges secondary to chronic pressure. Repeated topical treatments with permethrin and oral ivermectin led to the considerable resolution of her lesions. CONCLUSION: We present a rare case of crusted scabies with osteolysis in an immunocompetent female.