(Last Updated On: July 13, 2020)

Samantha E. Nadela, MD, Marie Claudine Francesca B. Perlas, MD,  Heirich Fevrier P. Manalili, MD, Johannes F. Dayrit, MD, FPDS

ABSTRACT

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.

Key words: Norwegian scabies, infant, topical corticosteroid

Citation:
Nadela SE, Perlas MCFB, Manalili HFP, Dayrit JF. Crusted (Norwegian) scabies in an infant a case report. Journal of the Philippine Dermatological Society 2019, 29(1), 96-99

1. Lima FCR, Cerqueira AMM, Guimarães MBS, Padilha CBS, Craide FH, Bombardelli M. Crusted scabies due to indiscriminate use of glucocorticoid therapy in infant. An Bras Dermatol. 2017;92(3):383-5.

2. Baysal V, Yildirim M, Turkman C, Aridogan B, Aydin G. Crusted scabies in a healthy infant. J Eur Acad Dermatol Venereol. 2004;18:188-190.

3. Mila-Kierzenkowska C, Woźniak A, Krzyżyńska-Malinowska E, Kałużna L, Wesołowski R, Poćwiardowski W, Owcarz M. Comparative Efficacy of Topical Permethrin, Crotamiton and Sulfur Ointment in the Treatment of Scabies. J Arthropod-Borne Dis. March 2017,11(1):1–9.

4. Binic I. Crusted Scabies following systemic and topical corticosteroid use. J Korean Med. Sci. 2010;25:188-191.

5. Al Jaff DAA, Amin MHM. Comparison on the effectiveness of sulphur ointment, permethrin and oral ivermectin in the treatment of scabies. Res J Pharm Biol Chem Sci. 2018;9(1):670-76.

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