North Texas Research Forum 2024



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North Texas


Medical City Fort Worth



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scabies, parasitic diseases


Dermatology | Medicine and Health Sciences | Skin and Connective Tissue Diseases


Introduction: Scabies is a parasitic dermatologic condition that often presents as an extremely pruritic rash. A rare and highly contagious variant of scabies is crusted scabies, formerly known as Norwegian scabies. Crusted scabies presents with hyperkeratotic papules and plaques, most commonly on the palms and soles. Due to the variety of presentations seen in scabies, it can be difficult to diagnose. Case presentation: Case 1: An 89-year-old male with a history of dementia, anxiety, and benign prostatic hyperplasia presented with a 2-month history of a generalized pruritic rash. He lived in a memory care center. The physical exam showed an erythrodermic, cachectic, and diaphoretic patient with scattered erythematous papules, with white hyperkeratotic scale on the trunk. Microscopic examination of skin scaping showed scabies mites, ova, and scybala confirming the diagnosis of crusted scabies. Case 2: A 22-year-old male with a history of trisomy 21 presented with a 10-month history of a mildly pruritic, thick, scaly rash on his bilateral hands and a generalized non-pruritic rash on his trunk, arms, and legs. They report they had seen multiple physicians prior who had prescribed him many medications including topical antifungals. On physical exam, there were thick, hyperkeratotic, white-yellow scaly plaques on the bilateral hands with onycholysis of the fingernails. On the trunk, arms, and legs were pinpoint papules with overlying hemorrhagic crust. Microscopic examination of skin scrapings showed multiple ova and scybala. A punch and shave biopsy of the hands was performed which showed multiple scabies mites in the stratum corneum. Learning points: Crusted scabies is a highly contagious and rare variant of scabies. It is often seen in those who are immunosuppressed, have an underlying neurologic disorder, or are immobile. Patients may present with erythroderma which poses a risk for hypothermia, infection, and high-output heart failure. The mortality rate of crusted scabies is as high as 50% secondary to soft tissue infection and sepsis. Due to the high mite burden crusted scabies is much more contagious and can spread to persons without direct contact. Successful treatment of crusted scabies is more difficult than non-crusted scabies. Successful treatment requires longer treatment than treating usual scabies infestations. Additionally, public health treatment of contacts is needed to control outbreaks and prevent re-infection.

Original Publisher

HCA Healthcare Graduate Medical Education

Crusted Scabies: A Case Report



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