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      Crusted Scabies Complicated with Herpes Simplex and Sepsis

      case-report

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          Abstract

          Crusted scabies is a rare and extremely contagious infestation by Sarcoptes scabiei. Kaposi’s varicelliform eruption (KVE) refers to herpes simplex virus infection superimposed on pre-existing dermatosis such as atopic dermatitis, Darier’s disease, and pemphigus. We report a case of KVE superimposed on crusted scabies in a middle-aged woman. Her condition was complicated with sepsis. She was treated with IV meropenem, vancomycin, and acyclovir and was released 2 weeks later in good condition. To our knowledge, only rare cases of crusted scabies complicated by KVE have been reported.

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          Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature.

          S Huffam, David Walton, Lauren Currie … (2005)
          To describe the clinical and immunological features of crusted scabies in a prospectively ascertained cohort of 78 patients. All patients requiring inpatient treatment for crusted scabies in the 'top end' of the northern territory of Australia over a 10 year period were prospectively identified. Demographics, risk factors, and immunological parameters were retrospectively compiled from their medical records and pathology databases. More than half the patients with crusted scabies had identifiable immunosuppressive risk factors. Eosinophilia and elevated IgE levels occurred in 58% and 96% of patients, respectively, with median IgE levels 17 times the upper limit of normal. Seventeen percent had a history of leprosy but 42% had no identifiable risk factors. There was a decrease in mortality after the introduction of a treatment protocol consisting of multiple doses of ivermectin combined with topical scabicides and keratolytic therapy. Crusted scabies often occurs in patients with identifiable immunosuppressive risk factors. In patients without such risk factors, it is possible that the crusted response to infection results from a tendency to preferentially mount a Th2 response. The treatment regime described was associated with a reduction in mortality. This is the largest reported case series of crusted scabies.
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            S1 guidelines on the diagnosis and treatment of scabies - short version.

            Cord Sunderkötter, Hermann Feldmeier, Regina Fölster-Holst … (2016)
            The goals of this German guideline are the improvement of diagnosis and therapy of scabies, the implementation of a coordinated action in outbreaks of scabies, and the control of this infestation in large migration or refugee flows.Sarcoptes scabiei var. hominis is transmitted by direct skin-to-skin contact of sufficient duration. The infectivity of female mites when removed from patients does not exceed 48 hours at room temperature (21°C) and relative humidity of 40-80%. The risk of infection rises proportionally to the number of mites on the skin and is particularly high in crusted scabies. As elderly persons tend to develop crusted scabies due to disease- or medication-related immunosuppression, there is an increased risk for outbreaks of scabies at nursing homes and extended-care facilities. The guideline contains detailed recommendations for management of such outbreaks. In refugees the prevalence of scabies is higher than in the general population in Germany, but the risk for outbreaks is not high. Scabies infestation should be considered when a recent onset of itching is associated with eczema and presence of burrows or comma-like papules at predilection sites. It is confirmed by dermatoscopic detection of mites or by microscopic identification of mites, mite eggs or fecal matter (scybala) from skin scrapings.The treatment of choice for common scabies is topical permethrin 5% cream applied for 8-12 hours. Permethrin can be considered for off-label use also in infants of less than 3 months of age and pregnant women. For this group crotamiton is another option, which, besides benzyl benzoate, presents a good second line therapy for the other indications. Indications for oral ivermectin, which has just been licensed in Germany, include patients with immunosuppression, severe dermatitis, and low adherence.Crusted scabies is preferentially treated by a combination of topical permethrin and oral ivermectin. Affected patients should be isolated, and all contact persons should be treated. The guideline contains lists for additional measures, including possible treatment of contact persons, clothes, linen and other possibly infested articles.
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              Crusted (Norwegian) scabies: an under-recognized infestation characterized by an atypical presentation and delayed diagnosis.

              O Yélamos, J Mir-Bonafé, A Lopez-Ferrer … (2016)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Dermatol
                Journal ID (iso-abbrev): Indian J Dermatol
                Journal ID (publisher-id): IJD
                Title: Indian Journal of Dermatology
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0019-5154
                ISSN (Electronic): 1998-3611
                Publication date (Print): Jul-Aug 2020
                Volume: 65
                Issue: 4
                Pages: 304-306
                Affiliations
                [1] From the Department of Dermatology, Tehran University of Medical Sciences (TUMS), Tehran, Iran
                [1 ] Dermopathology, Razi Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
                [2 ] Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
                [3 ] Department of Dermatology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
                Author notes
                Address for correspondence: Dr. Safoura Shakoei, Department of Dermatology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran - 1419733141, Iran. E-mail: dr.shakoei@ 123456gmail.com
                Article
                Publisher ID: IJD-65-304
                DOI: 10.4103/ijd.IJD_463_18
                PMC ID: 7423228
                PubMed ID: 32831373
                SO-VID: 0c5d7010-1240-400a-8f49-f0c85332fe35
                Copyright © Copyright: © 2020 Indian Journal of Dermatology
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : September 2018
                Date accepted : November 2018
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Dermatology
                Keywords: crusted scabies,kaposi varicelliform eruption,scabies
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: crusted scabies, kaposi varicelliform eruption, scabies

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