FIgure 4 - available via license: Creative Commons Attribution-NonCommercial 4.0 International
Content may be subject to copyright.
Dermoscopy of the child's inflammatory lesion: triangular structures (delta-shaped), which represent the parasite's head and front paws (x10)
Source publication
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 in...
Similar publications
We report an atypical presentation of a common disease to highlight the importance of making a correct diagnosis of scabies surrepticius in front of any itchy dermatosis especially in elderly patients. The misdiagnosis of this disease results in extensive infestation, especially with the use of corticosteroids. Scabies is a common parasitic infecti...
Citations
... Furthermore, it can also cause osteomyelitis, endocarditis, and potentially fatal bacterial sepsis. Screening for methicillin-resistant Staphylococcus aureus (MRSA) and choosing proper medications are crucial for better management of cases (Romani et al. 2015b;Yeoh et al. 2016;Lima et al. 2017;Engelman and Steer 2018). ...
Scabies is an itchy skin disease caused by the burrowing mite Sarcoptes scabiei . During their lifespan, the female mites invade the stratum corneum and create tunnels, in which they reside, move, feed, deposit fecal pellets, and lay eggs. Recently, scabies was included in the World Health Organization roadmap for neglected tropical diseases 2021–2030. This review attempts to summarize our knowledge about the mite’s biology and the disease pathogenesis, pathological changes, and complications. Generally, the host–parasite interaction in scabies is highly complex and involves different mechanisms, some of which are yet largely unknown. Elucidation of the nature of such interaction as well as the underlying mechanisms could allow a better understanding of the mite’s biology and the development of novel diagnostic and therapeutic options for scabies control programs. Moreover, identification of the molecular basis of such interaction could unveil novel targets for acaricidal agents and vaccines.
... Using less specific diagnostic criteria may result in misdiagnosis since there are several differential diagnoses mimicking scabies, resulting in the spread of scabies in families or institutions or the application of incorrect treatment modalities (e.g. steroids for presumed eczema in young children with scabies leading to crusted scabies [32]). Our survey showed that almost all dermatologists correctly treat close contacts simultaneously [11,33]. ...
Aim of the study:
The global prevalence of scabies is estimated to be up to 200 million cases annually, with young children particularly affected. In Europe, most cases are thought to originate in migrant populations. Scabies management is challenging in children. To identify knowledge gaps and research needs, we aimed to descriptively evaluate the management of children with scabies by different Swiss healthcare providers.
Methods:
An invitation for an anonymous online survey (36 questions) was sent to members of Swiss societies of dermatologists, general practitioners, paediatricians, paediatric dermatologists, paediatric infectious diseases specialists, and tropical medicine specialists, inviting clinicians to participate from 25th May to 8th August 2020. One reminder invitation was sent. Hospital pharmacies and the distributor of permethrin were contacted to report consumption trends of scabicides in 2018 and 2019.
Results:
The survey was completed by 248 clinicians: 146 (59%) paediatricians, 47 (19%) dermatologists, 28 (11%) general practitioners, 6 (2%) paediatric dermatologists, 13 (5%) paediatric infectious diseases specialists, and 8 (3%) tropical medicine specialists. Most consulted up to 10 scabies cases within a 16-month period, with similar numbers in migrant and Swiss children. Dermoscopy was used by 24% of non-dermatologists. Non-dermatologists did not consider co-treatment of close contacts in up to 59% of cases. While permethrin was the first-line treatment, treatment failures were frequently reported in children aged <5 years. Up to 67% of paediatric dermatologists regularly used oral ivermectin off-label in children weighing <15 kg. None of the paediatric dermatologists, 15% of the dermatologists, and 9% of the non-dermatologists used only one treatment cycle.Scabicide consumption increased. Treatment studies on ivermectin use in children weighing <15 kg had the highest research priority.
Conclusion:
In Switzerland, scabies is a frequent dermatosis in migrant and Swiss children. While accessible, optimal diagnostics are underutilised, and treatment is suboptimal. Permethrin resistance appears to be an increasing problem. Dermatologists regularly use ivermectin off-label in children weighing <15 kg. Treatment studies on ivermectin use in children weighing <15 kg, user-friendly diagnostic tools, new treatment protocols, and child-friendly dosage forms are needed to improve the diagnosis and treatment of children with scabies.
... In another study, Norwegian scabies was confused with other dermatological diseases. [20] Permethrin, benzyl benzoate, sulfur-containing compounds, and crotamiton are the topical agents, and ivermectin as a systemic agent is used to treat scabies. [1,2,5] In our study, the majority of physicians correctly knew the agents used in the treatment of scabies. ...
... 1,2,4,5 Some infants with crusted scabies are due to misuse of topical corticosteroids. 6,7 Our infant presented with generalized pruritic rashes with palmoplantar scales/crusts and toenail involvement. The mild facial hirsutism may imply potential corticosteroid components of self-made ointments. ...
... Many of these differential diagnoses are treated with steroid, which will further be delayed the correct diagnosis. 14,15 In this case, family history played a role that could elucidate the presence of scabies infection. Unfortunately, the patient was treated with high-potent topical corticosteroids over a long period of time which induced the immunosuppression state ascribed to the development of Norwegian scabies. ...
Background: Scabies is a highly contagious skin disease with various skin clinical presentations. In consideration of its clinical presentations, proper early-onset diagnosis of scabies may not be met, leading to mistreatment and more severe scabies, Norwegian (crusted) scabies. Purpose: To report a case of Norwegian scabies misdiagnosed as eczema in a previously immunocompetent patient. Case: A 32-year-old man was admitted with generalized erythematous skin rash, pruritic, and hyperkeratotic scales of the body. He was previously diagnosed with eczema two months ago and was prescribed both topical and systemic steroid. Skin scales worsened and kept expanding after the treatment. There was a family history of nocturnal itch. Dermoscopic and microscopic examination from skin lesion and scraping with potassium hydroxide revealed the signs of scabies infection. Discussion: Norwegian scabies could be prevented by the correct diagnosis at the early-onset of the disease. Misdiagnosis due to various skin clinical presentations, leading to mistreatment of the infection. In this case, family history plays a role that could elucidate the presence of scabies infection. Conclusion: A correct diagnosis and treatment for the early-phase scabies-infected patient will be beneficial for the patient to prevent hyperinfestation of scabies mites. Specific examination for scabies decreases the possibility of misdiagnosis.
... The major risk factor demonstrated by our patient was chronic drug-induced immunosuppression. As immunosuppressive medications are becoming more commonly prescribed and immunocompromised patients enjoy longer lives, crusted scabies infestations can be expected to increase in frequency [13]. Thus, it is important to include scabies in the differential of refractory pruritus, even in nonclassic presentations. ...
Scabies infection is a very common skin disease that occurs due to infestation with the Sarcoptes scabei mite. Typically, it results in intensely pruritic papules and excoriations in the webs of the hand, groin, or axilla, and remains limited in its spread. In rare cases, the disease can become diffuse and progress to crusted or nodular subtypes. Here, we report the case of crusted scabies infestation in a 69-year-old male who presented with a diffuse pruritic, erythematous, and petechial rash. His medical history was significant for severe idiopathic urticaria treated with omalizumab. Before starting omalizumab, the patient was self-medicating for several months with corticosteroids obtained through his veterinary practice to alleviate symptoms. His presentation was complicated by immune thrombocytopenic purpura and muscle weakness, likely secondary to omalizumab and corticosteroid use, respectively. The patient underwent an extensive rheumatologic workup until skin biopsy confirmed the underlying etiology as crusted scabies infestation. He was treated with ivermectin and weekly 5% permethrin skin cream with great improvement of his rash; however, unfortunately, he succumbed to bacterial sepsis. Scabies infestation can masquerade as a manifestation of other systemic diseases and is often misdiagnosed. As this case illustrates, initial misdiagnosis and subsequent treatment with immunosuppressive drug regimens can cause preventable, but potentially fatal, concomitant superinfections.
... 24 The prevalence of scabies worldwide is estimated to be between 200 and 300 million cases per annum, affecting all age groups. 25 However, it is most well established in vulnerable groups such as children, immunocompromised and elderly people as well as in people located in resource-poor communities in the developing world, where overcrowding, poor sanitation and socioeconomic disadvantage coexist, causing significant human morbidity and mortality. 2,8,24,[26][27][28] Children carry the highest burden of disease with the highest prevalence of scabies being in children under 2 years old. ...
... Crusted scabies, exceedingly rare in children, is characterized by a severe infestation of millions of mites resulting in hyperkeratotic plaques or 'crusted skin'. 25,37,38 When seen in children, crusted scabies has a predilection for immunocompromised and chronically ill children. 39,40 It is a ...
... [41][42][43] S. aureus can cause superficial acute impetiginization, abscesses, cellulitis, echthyma, paronychia and furunculosis but can progress to osteomyelitis, endocarditis and life-threatening bacterial sepsis. 25,28,37,42 Screening for methicillin-resistant S. aureus (MRSA) and the selection of targeted antibiotics are important considerations for the treating team. ...
This narrative review addresses scabies, a highly contagious, pruritic infestation of the skin caused by the mite Sarcoptes scabiei var hominis. Scabies is a common disorder that has a prevalence worldwide estimated to be between 200 and 300 million cases per year. Infestation is of greatest concern in children, the elderly, immunocompromised people and resource-poor endemic populations at risk of chronic complications. A diagnosis of scabies involves a clinical suspicion, a detailed targeted history, clinical examination and contact tracing. Dermoscopy and microscopy, where available, is confirmatory. Due to its infectivity and transmissibility, the management for scabies requires a multimodal approach: topical antiscabetic agents are the first line for most cases of childhood classic scabies and their contacts, which must also be identified and treated to prevent treatment failure and reacquisition. Environmental strategies to control fomite-related reinfestation are also recommended. Oral ivermectin, where available, is reserved for use in high-risk cases in children or in mass drug administration programmes in endemic communities. The prevention of downstream complications of scabies includes surveillance, early identification and prompt treatment for secondary bacterial infections, often superficial but can be serious and invasive with associated chronic morbidity and mortality. Post-scabetic itch and psychosocial stigma are typical sequelae of the scabies mite infestation. The early identification of patients with scabies and treatment of their contacts reduces community transmission. Although time consuming and labour intensive for caregivers, the implementation of appropriate treatment strategies usually results in prompt cure for the child and their contacts. Here, we provide a summary of treatments and recommendations for the management of paediatric scabies.
... Consistent with current findings, Norwegian scabies is a severe but rare clinical variant of scabies that has been confused with other dermatologic diseases as dermatitis. [24] Additionally, the ability of infected pets to transmit classic scabies to humans is a widespread misconception about scabies. [25] The inadequate knowledge observed in the current study was consistent with the fact that only one-third of the physicians were aware of the Saudi MOH guidelines for scabies, and approximately one-fourth of the physicians were unexposed to scabies information for a long period. ...
Background:
Outbreaks of scabies have been documented in 2018 among school children in Western and Central regions of Saudi Arabia. There have been concerns about the awareness of healthcare providers.
Objective:
The objective of the current study was to evaluate the knowledge of primary health care physicians about scabies diagnosis and management, as well as the factors influencing such knowledge.
Methods:
An observational cross-sectional study was conducted between September and October 2019. The target population was physicians working in primary care centers in Riyadh. Filling either hard or soft copies of the study questionnaire was used for data collection. The knowledge score was calculated from the answers for 16 knowledge questions.
Results:
A total of 216 physicians were included in the final analysis, mainly general practitioners (56.5%) and registrars (31.5%). The overall knowledge score was 67.5%± 13.9%. The highest level of knowledge was associated with age susceptibility (80.6%), followed by clinical presentation and diagnosis (78.1%), mode of transmission (75.8%), pathogen cause & incubation period (66.9%), and finally management (61.7%). In multivariate logistic regression models, a shorter time since last time information about scabies was reviewed was significantly associated with better knowledge (defined as score > median), with odds ratio = 5.84 (95% confidence interval = 2.43-14.01). Similarly, older age and higher qualification were significantly associated with better knowledge.
Discussion:
As expected, the knowledge about scabies among primary care physicians was generally inadequate. The current findings highlight the need for educational and training programs lead by health care authorities, targeting these physicians.
... Crusted scabies presentation in children is variable and can present as keratoderma over acral surfaces, onychodystrophy, subungual hyperkeratosis, or erythrodermic dermatitis. 1,3 Pruritus is variable. ...
... One reported case of crusted scabies was associated with fatal staphylococcal sepsis and endocarditis. 1 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. 5,6 Crusted scabies might be misdiagnosed as inherited PPK and can mimic various diseases such as psoriasis, eczema, or seborrheic dermatitis. ...
... Crusted scabies usually occurs in immunocompromised individuals such as those with congenital immunodeficiency disorders (especially cell-mediated immunodeficiency), acquired immunodeficiency syndrome (AIDS)/ human immunodeficiency virus (HIV) infection, immunosuppressive treatment (e.g., corticosteroids, calcineurin inhibitors, and cytotoxic drugs), graft-versus-host disease, malignancies (e.g., leukemia and lymphoma), and systemic diseases (diabetes mellitus, systemic lupus erythematosus, dermatomyositis, chronic mucocutaneous candidiasis, and dystrophic epidermolysis bullosa) [6,8,10,11]. Other predisposing factors include malnutrition, physical debilitation (senility, sensory or motor neuropathy, leprosy, and paraplegia), and mental retardation (especially Down syndrome) [2,5,8,12,13]. ...
... e diagnosis was confirmed by observation of a mite on microscopic examination of material scraped from the lesions. ere were a few case reports of immunocompromised infants with crusted scabies [1,10,14,15]. In 2006, Ruiz-Maldonado reported a 2½month-old infant with scabies who was misdiagnosed as atopic dermatitis at 3 weeks of age and treated with topical pimecrolimus 1% cream twice a day [15]. ...
... In 2014, Rose et al. reported crusted scabies in a 4-month-old human immunodeficiency virus-(HIV-) positive infant who presented with papular lesions all over the body and crusted scaly lesions over the soles and palms [14]. In 2017, Lima et al. described a 4-month-old Mulatto boy who had miliaria rubra-like lesions on the neck and folds of the upper and lower limbs since 2 months of age [10]. e infant was treated with various medications including oral prednisolone (0.8 mg/kg/day) for 7 days and a single-dose ampoule of betamethasone given intramuscularly. ...
Crusted scabies (also known as Norwegian scabies) is a highly contagious variant of scabies characterized by profuse proliferation of mites in the skin and widespread, crusted, hyperkeratotic papules, plaques, and nodules. Typically, pruritus is minimal or absent. The condition usually occurs in immunocompromised individuals. Occurrence in healthy infants has rarely been reported. We report an 11-month-old healthy Malay boy who presented with crusted scabies.
