(Last Updated On: October 29, 2018)

Authors: 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 mainly 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 Presentation: We present a case of a  2-month-old healthy Filipino male, who was previously managed as a case of miliaria rubra and treated with clobetasol + ketoconazole cream for 1 week. The papules 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 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 hypoallergic 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 option.

 

Citation

 

Keywords

Norwegian scabies, infant, topical corticosteroid

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