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.

Cushing Syndrome due to Inappropriate Corticosteroid Topical Treatment of Undiagnosed Scabies

“…Whilst common scabies, without secondary bacterial infection, is not life threatening and can be treated simply in many patients, this case series demonstrates that the uncontrolled and chronic use of high potency steroids, including clobetasol and betamethasone, can lead to potentially harmful complications such as Cushing syndrome and other endocrine disorders as well as the development of crusted scabies [ 7 , 14 ]. Patients with crusted scabies have intense scaling on the palms and soles and numerous nodular lesions on axillary and inguinal folds as well as on the scrotum for boys and diaper rim on the waist [ 15 ] ( Figure A3 ). Topical or systemic glucocorticoids should be used with caution and never as a treatment for scabies in children.…”

An unsual case of palmoplantar keratoderma

“…It is often associated with immunodeficiency, motor or sensory deficiency (due to an inability to scratchor experience itch), or mental retardation. Occurrence after topical application of corticosteroids in individuals without any other risk factors has been also reported . It presents as thick, scaling, hyperkeratotic lesions, affecting the whole body, mainly the face, neck, scalp, and subungual region.…”

“…It presents as thick, scaling, hyperkeratotic lesions, affecting the whole body, mainly the face, neck, scalp, and subungual region. Crusted scabies presentation in children is variable and can present as keratoderma over acral surfaces, onychodystrophy, subungual hyperkeratosis, or erythrodermic dermatitis . Pruritus is variable.…”

“…Pyoderma, erysipelas, cellulitis, and sepsis are acute secondary infectious complications that can induce life‐threatening consequences. One reported case of crusted scabies was associated with fatal staphylococcal sepsis and endocarditis . In addition, patients can develop more frequently two sequelae of GAS infections such as acute post‐streptococcal glomerulonephritis and acute rheumatic fever, which can progress to chronic heart failure and chronic renal failure …”

Erythroderma due to iatrogenic immunosuppression: a case of Norwegian scabies

“…Itching is a result of hypersensitivity and is thus less prominent in patients with immune deficiency. Also neurologically impaired patients do not perceive itch and are predisposed to itching [4].There have been very few reports of crusted scabies in patients receiving immunosuppressive drugs including systemic and topical steroids [5][6][7]. The disease may present as crusted plaques, psoriasiform lesions or as erythroderma [4,8].The diagnosis requires a high index of suspicion.…”