J Korean Med Sci.  2010 Jan;25(1):188-191. 10.3346/jkms.2010.25.1.188.

Crusted (Norwegian) Scabies Following Systemic and Topical Corticosteroid Therapy

• Binic I
• Jankovic A
• Jovanovic
• Ljubenovic M

• KMID: 1713857
• DOI: http://doi.org/10.3346/jkms.2010.25.1.188

Abstract

It is a case study of a 62-yr-old female with crusted (Norwegian) scabies, which appeared during her treatment with systemic and topical corticosteroid therapy, under the diagnosis of erythroderma. In the same time, the patient had been suffered from hypothyoidism, and her skin changes were misdiagnosed, because it was thought that they are associated with her endocrine disorder. Suddenly, beside the erythema, her skin became hyperkeratotic, with widespread scaling over the trunk and limbs, and crusted lesions appeared on her scalp and ears. The microscopic examination of the skin scales with potassium hydroxide demonstrated numerous scabies mites and eggs. Repeated topical treatments with lindan, benzoyl benzoat and 10% precipitated sulphur ointment led to the complete resolution of her skin condition.

Keyword

Sarcoptes Scabiei; Diagnosis; Therapy

MeSH Terms

Administration, Topical
Antiparasitic Agents/therapeutic use
Dermatitis, Exfoliative/diagnosis/therapy
Diagnostic Errors
Female
Glucocorticoids/*administration & dosage
Humans
Middle Aged
Scabies/*diagnosis/drug therapy
Skin/pathology
Antiparasitic Agents
Glucocorticoids

Figure

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  Fig. 1 Hyperkeratotic plaques on trunk and limbs and crusted lesions on her scalp and external ears.

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  Fig. 2 Hyperkeratotic plaques on trunk and limbs and crusted lesions on her scalp and external ears (A, B, C, D).

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  Fig. 3 Microscopical examination of scrapings from the hyperkeratotic lesions from trunk showed (arrow) mites (M) and eggs (E) (magnification ×40).

Reference

1. Landwehr D, Keita SM, Ponnighaus JM, Tounkara C. Epidemiologic aspects of scabies in Mali, Malawi and Cambodia. Int J Dermatol. 1998. 37:588–590.

2. Cox NH, Paterson WD. Epidemiology of scabies: the new epidemic. Lancet. 1991. 337:1547–1548.

3. Burns DA. Champion RH, Burton JL, Burns DA, Breathnach SM, editors. Diseases caused by arthropods and other noxious animals. Rook, Wilkinson Textbook of Dermatology. 1998. 6th ed. Oxford: Blackwell Science;1423–1482.

4. Portu JJ, Santamaria MJ, Zubero Z, Almeida-Liamas M, Etxebarria San Sebastian MA, Gutierrez AR. Atypical scabies in HIV positive patients. J Am Acad Dermatol. 1996. 34:915–917.

5. Suzumiya J, Sumiyoshi A, Kuroki Y, Inoue S. Crusted (Norwegian) scabies with adult T-cell leukemia. Arch Dermatol. 1985. 121:903–904.

6. Dourmishev AL, Serafimova KD, Dourmishev AL, Mualla AM, Papaharalambous V, Malchevsky T. Crusted scabies of the scalp in dermatomyositis patients: three cases treated with oral ivermectin. Int J Dermatol. 1998. 37:231–234.

7. Van der Wal VB, Van Voorst Vader PC, Mandema JM, Jonkman MF. Crusted (Norwegian) scabies in a patient with dystrophic epidermolysis bullosa. Br J Dermatol. 1999. 141:918–921.

8. Paterson WD, Allen BR, Beverige GW. Norwegian scabies during immunosuppressive therapy. Br Med J. 1973. 4:211–212.

9. Jaramillo-Ayerbe F, Berrio-Munoz J. Ivermectin for crusted Norwegian scabies induced by use of topical steroids. Arch Dermatol. 1998. 134:143–145.

10. Cestarri FT, Martignago FB. Scabies, pediculosis, bedbegs, and stinkbugs: uncommon presentations. Clin Dermatol. 2005. 23:545–554.

11. Kim KJ, Roh KH, Choi JH, Sung KJ, Moon KC, Koh JK. Scabies incognito presenting as urticaria pigmentosa in an infant. Pediatr Dermatol. 2002. 19:409–411.

12. Hengge UR, Currie BJ, Jager G, Lupi O, Schwartz RA. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis. 2006. 6:769–779.

13. Guldbakke KK, Khachemoune A. Crusted scabies: a clinical review. J Drugs Dermatol. 2006. 5:221–227.

14. Marliere V, Roul S, Labreze C, Taieb A. Crusted (Norwegian) scabies induced by use of topical corticosteroids and treated successfully with ivermectin. J Pediatr. 1999. 135:122–124.

15. Roberts LJ, Huff am SE, Walton SF, Currie BJ. Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature. J Infect. 2005. 50:375–381.

16. Gladstone HB, Darmstadt GL. Crusted scabies in an immunocompetent child;treatment with ivermectin. Pediatr Dermatol. 2000. 17:144–148.

17. Arya V, Molinaro MJ, Majewski SS, Schwartz R. Pediatric scabies. Cutis. 2003. 71:193–196.

18. Sugimoto T, Kashiwagi A. A case of scabies masquerading as drug eruption. Eur J Intern Med. 2007. 18:445–446.