Crusted Scabies

By Ted Rosen, MD | January 28, 2013

Dr Rosen is Professor of Dermatology at Baylor College of Medicine and Chief of the Dermatology Service at the Veterans Affairs Medical Center, both in Houston, Texas.

A 40-year-old woman who had been receiving prednisone(Drug information on prednisone) and azathioprine(Drug information on azathioprine) for the treatment of systemic lupus erythematosus complained of a widespread, intensely pruritic, heavily scaling rash.

Key point: The combination of itching massive scaling suggests the diagnosis of crusted scabies. This variety of scabies is seen in those who are immunosuppressed or immunocompromised (typically HIV+). A mineral oil scraping of the scale should easily demonstrate mites, as it did in this case.

Treatment: Repeated oral doses of ivermectin(Drug information on ivermectin) along with topical permethrin(Drug information on permethrin) application were required to clear her infestation.

Note: This is highly contagious. All household members should be treated on prophylactic basis.

by susan kweskin | June 10, 2013 9:44 AM EDT

Dr. Rosen responds:

Thanks for your comment.

Crusted scabies is typically seen in immunosuppressed or immunocompromised patients. While they still perceive the sensation of pruritus, their underlying medical conditions preclude the immune system from mounting an appropriate response. That's why mites are innumerable and that's also why the visible inflammation is much less than one might expect considering the degree of infestation. These mites are not follicular, but rather burrow throughout the uppermost portion of the epidermis.

The differential includes severe ichthyosis, ostraceous psoriasis, and lichen simplex chonicus.

by Nathaly Isidore-Blackmore | June 06, 2013 4:12 PM EDT

Greetings all!
What are all the other things this could be mistaken for ?
I was really surprised that there seemed to be minor redness or inflammation .
Were the nids located close to hair follicles?
Thank you for the thought provoking presention
Cheers!
Nathaly

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Nutritional/Metabolic

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Crusted Scabies

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