Norwegian scabies presenting as erythroderma: A case report.

BACKGROUND: Norwegian scabies (NS) is a serious parasitic skin condition. Although NS is one of the causes of erythroderma, it is frequently overlooked. Therefore, it is essential to raise awareness regarding NS presenting as erythroderma. CASE SUMMARY: We present a case of NS that persisted for more than 3 years. After following nonstandard treatment, the patient's rash worsened and gradually progressed into erythroderma. Finally, NS was diagnosed by skin microscopy and pathology. CONCLUSION: When patients with pruritic dermatosis have high-risk factors such as prolonged bed rest and immunodeficiency, clinicians need to enhance their awareness of NS and ensure prompt diagnosis and treatment.

Norwegian scabies in human immunodeficiency virus and tuberculosis-infected child: A case report.

Norwegian scabies is a rare scabies with the manifestation of thick crusts of the extremities of the skin that contain eggs and mites. Several conditions in which scabies infection is easily transmitted include immunocompromised, home nursing, and severe neurological disorder. The aim of this case report was to present a thorough analysis of a comprehensive resource for the management of Norwegian scabies patients, with a specific focus on individuals who also have HIV or other immunocompromising diseases. A 1-year-and-7-month-old boy was presented to the hospital with a chief complaint of a thick crust that he had experienced for four months. It began as a red papule in the lower extremity, then crusted and spread to the whole body. The patient kept scratching due to itching, had a recurrent fever and diarrhea for three months, and cough for one month. The patient was diagnosed with human immunodeficiency virus (HIV) and pulmonary tuberculosis at three months, suspected to get the infection from the parents. Sarcoptes scabiei was found from microscopy examination of skin scraping. The patient received holistic treatment, including antiretroviral drugs, antituberculosis medication, scabies treatment, and malnutrition treatment. Appropriate scabies treatment aimed at peeling crusted skin, relieving itching, and increasing the patient ability to use the extremities. Comorbidity conditions caused by HIV and pulmonary tuberculosis should also be treated to optimize the outcome. The patient was discharged in good condition with sanitation education and regular follow-up at the outpatient clinic. This case highlights that Sarcoptes scabiei infestation may be a clue to an immunocompromised condition. Holistic therapy aiming to cure underlying infection, infestation and underlying nutrition and psychosocial problems must be addressed to fully cure this high-burden case.

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.

The hidden scabies: a rare case of atypical Norwegian scabies, case report and literature review.

BACKGROUND: Norwegian scabies is a rare dermatological manifestation that usually affects the most fragile populations, such as elderly and immunocompromised patients, and its diagnosis is quite complex, due to its low prevalence in the general population and because of a broad spectrum manifestation. CASE PRESENTATION: Here we describe a rare case of Norwegian scabies that was previously misdiagnosed in a sixteen year old patient affected by Down syndrome and we conducted a non-systematic literature review about this topic. Lesions were atypical, pruritic and associated with periodic desquamation of the palms and soles and after a series of specialist evaluations, she finally underwent topical treatment with complete remission. CONCLUSION: It is therefore crucial to take in consideration the relation between Down syndrome and community acquired crusted scabies, to enable preventative measures, early detection, and proper treatment.

Combination of Crusted Scabies with Bullous Scabies: A Rare Case.

Scabies is a parasitic skin disease caused by Sarcoptes scabiei var. hominis. Crusted scabies, also known as Norwegian scabies, is a rare and severe form of scabies that occurs more frequently in immunocompromised, elderly, disabled, and debilitated patients. The present study reports a case of crusted scabies combined with bullous scabies. A 44-year-old man was admitted with the chief complaint of red, thick, scaly patches of skin accompanied by crusting that felt itchy and worsened at night. The lesions had appeared all over his body intermittently for the last 10 years; however, the complaints worsened in the last 2 months. From dermatological status, the anterior and posterior thoracic regions and between the fingers of both hands showed generalized distribution of erythematous, yellowish, hyperkeratotic plaques with clear boundaries, pustules, and blisters on an erythematous base with multiple erosions and excoriations. S. scabiei were found on skin scraping examination, and histopathological examination supported the diagnosis of bullous scabies. The patient received 5% permethrin lotion topical therapy and systemic ivermectin therapy. In addition, the patient was given systemic antibiotics. The lesions improved after 2 weeks of therapy, and no S. scabiei were found on the subsequent microscopic examination. Treatment with a combination of topical and systemic scabicidal agents produced a favorable outcome in this patient.

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.

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.

Norwegian scabies in HIV/AIDS.

This case describes a patient presenting with significant crusting on his upper and lower extremities found to be Norweigan scabies, which led to a diagnosis of HIV and then AIDS. Norweigan scabies should be considered in the setting of an atypical dermatologic presentation that has failed multiple outpatient therapies.

Mass drug administration campaigns for scabies and impetigo: protocol for a systematic review and meta-analysis.

Introduction: Scabies is recognised as a neglected tropical disease, disproportionately affecting the most vulnerable populations around the world. Impetigo often occurs secondarily to scabies. Several studies have explored mass drug administration (MDA) programmes, with some showing positive outcomes-but a systematic evaluation of such studies is yet to be reported. The main aim of this systematic review is to generate comprehensive evidence on the effect and feasibility of MDA programmes in reducing the burden of scabies and impetigo. Methods and analysis: A systematic review and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Electronic databases to be searched will include CINAHL EBSCOhost, Medline Ovid, ProQuest, Science Direct, PubMed and SCOPUS. In addition, grey literature will be explored via the Australian Institute of Health and Welfare, Australian Indigenous HealthInfoNet, Informit, OaIster database and WHO. No language restrictions will be applied. All treatment studies following an MDA protocol, including randomised/quasi-controlled trials, and prospective before-after interventional studies, will be considered. The main outcome is the change in prevalence of scabies and impetigo The Cochrane collaboration risk of bias assessment tool will be used for assessing the methodological quality of studies. A random-effect restricted maximum likelihood meta-analysis will be performed to generate pooled effect (OR) using STATA V.16. Appropriate statistical tests will be carried out to quantify heterogeneity between studies and publication bias. Ethics and dissemination: Ethical approval is not required since data will be extracted from published works. The findings will be communicated to the scientific community through a peer-reviewed journal publication. This systematic review will present an evidence on the effect of MDA interventions on scabies and impetigo, which is instrumental to obtain a clear understanding of the treatments widely used in these programmes. PROSPERO registration number: CRD42020169544.

Crusted scabies in a pediatric renal transplant recipient on immunosuppressants.

BACKGROUND: Crusted scabies (CS) is a rare, severe and highly contagious form of scabies, which has been reported in immunosuppressed patients. A high index of suspicion and awareness of CS is essential to treat this infestation. CASE: A 13-year-old boy presented with pruritic hyperkeratotic squamous plaques located on both inner wrists, the web spaces of both his hands and his feet, and the genital area of 12 months duration. He was diagnosed with focal segmental glomerulosclerosis at the age of 5 and received a kidney transplant at the age of 9. He has been on a maintenance dose of prednisone (5 mg/d) and mycophenolate mofetil (250 mg/d) for the past 2 years. He had a contact history with a school friend with similar lesions. A skin punch biopsy demonstrated the presence of multiple mites in the stratum corneum confirming the diagnosis of CS. Ivermectin, the recommended drug of choice for crusted scabies, is not available in South Africa. The patient was commenced on topical benzoyl benzoate lotion but discontinued its use because of intolerable irritation. We subsequently prescribed the daily application of topical 5% sulfur in petrolatum to which his pruritus subsided significantly after 2 weeks with resolution of all skin lesions at the end of 8 weeks. CONCLUSION: This case is the first documented report of CS in a pediatric renal transplant patient. Our management highlights that classic formularies of magistral drugs are still effective treatment options and can be used especially when standard therapies cannot be tolerated or when optimum treatments are not available.

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.

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.