An Itchy Problem: A Clinical Case of Crusted Scabies

Abstract

Scabies is an infestation of the skin by the mite Sarcoptes scabiei. A more severe form called crusted or Norwegian scabies may occur in immunosuppressed patients and the elderly. Crusted scabies mostly differs from normal scabies by the exuberance of its lesions, body distribution and high contagiousness, and requires different and more prolonged treatment. Early recognition of the lesions and isolation precautions are crucial for disease control and prevention of transmission. The authors describe a clinical case of crusted scabies with pruritus and exuberant cutaneous lesions. LEARNING POINTS• Crusted scabies is an infestation of the skin by the mite Sarcoptes scabiei that is highly contagious and results in an intensely pruritic eruption with exuberant cutaneous lesions. • Crusted scabies occurs in patients with AIDS, lymphoma or compromised cellular immunity, and sometimes in older patients. It is characterized by an elevated burden of mites and does not have a characteristic distribution pattern.• This disease requires strict isolation measures and treatment which differs from and is more prolonged than for scabies.

Pruritic Crusted Scabies in an Immunocompetent Infant

“…Crusted scabies is characterized by widespread erythroderma, hyperkeratosis, and crusting of the skin [8]. Lesions tend to be exaggerated on the soles, palms, ears, and extensor surface of the elbows [8, 9]. The crusts may be scaly and loose or adherent and thick [9].…”

“…Lesions tend to be exaggerated on the soles, palms, ears, and extensor surface of the elbows [8, 9]. The crusts may be scaly and loose or adherent and thick [9]. On removal of the crust, the skin surface appears smooth, velvety, and red [8].…”

Scabies in the Elderly: A Narrative Literature Review

“…Crust scabies was considered cured if, during monitoring 1-2 weeks after the end of treatment, there were no manifestations of active scabies, namely no active lesions, no nocturnal pruritus, and the discovery of mites, eggs, and scabies on skin scraping examination. 16 Although many topical therapies are available for the treatment of both classic and crusty scabies, elderly patients may have difficulty applying topical therapy because of limited mobility. Whenever possible, the patient should receive appropriate assistance to apply the medication.…”