Scabies crustosa B86.x1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Bark Scabies; crusted scabies; Norwegian scabies; scabies crustosa; scabies norvegica

History
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Danielssen and Boeck 1848; Hebra 1852

Definition
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In industrialized countries rare, excessive variant of the scabies with explosive reproduction of the scabies mites, severe eczematization up to pseudo-oichthyotic skin changes. There is a high infectivity due to the high pathogen density.

Manifestation
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Especially occurring in patients with disturbed immune system, e.g. diabetes mellitus, leukemia, AIDS, cachexia, after long-term glucocorticoid or cytostatic therapy. Cases of Scabies norwegica are also detected in patients who have been denied adequate therapy for years.

Localization
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Mostly symmetrical infestation. Especially hands, elbows, knees, ankles, face and capillitium are affected.

Clinical features
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Dirty-brown keratoses, bark, possibly redness and scaling on the whole integument. Hardly any itching. Extensive subungual hyperkeratosis, claw-like lifting of the distal nail plate. Mite ducts especially on Palmae and Plantae.

Histology
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Masses of scabies mites and ducts in the stratum corneum.

General therapy
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In addition, it is recommended that contact persons be identified and treated, that the patient be admitted to hospital, that he/she be isolated, that protective measures be taken by the nursing staff, that body and bed linen be changed daily, and that the room and utensils be disinfected daily.

External therapy
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There are no large studies available on the therapy of Scabies norwegica. Initially, keratolytic pre-treatment with 5-10% salicylic acid ointment(e.g. Salicylvaseline Lichtenstein, R228 ) over several days. Permethrin is mostly recommended for antiscabial therapy because it is easy to handle and well tolerated (for practical handling see below) . It is recommended to repeat the procedure after 1 week and if necessary after another week.

Internal therapy
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The use of ivermectin (Stromectol) 200-400 μg/kg KG p.o. as a single dose, synchronized with external therapy, is recommended. Repeat the therapy after 14 days.

Progression/forecast
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High recurrence rate with insufficient treatment of subungual hyperkeratosis and nails.

Note(s)
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Remember! Before administration of ivermectin, written information and consent of the patient is recommended!

Literature
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  1. Katsumata K et al (2003) Norwegian scabies in an elderly patient who died after treatment with gamma BHC. Internal Med 42: 367-369
  2. Perna AG et al (2004) Localised genital Norwegian scabies in an AIDS patient. Sex Transm Infect 80: 72-73
  3. Rütten A et al (1990) Scabies norwegica or Scabies crustosa. Act Dermatol 16: 140-142
  4. Scheinfeld N (2004) Controlling scabies in institutional settings:a review of medications, treatment models, and implementation. At J Clin Dermatol 5: 31-37
  5. Terri L et al (1995) The treatment of scabies with ivermectin. N Engl J Med 333: 26-30
  6. Wlotzke U et al (1992) Scabies norvegica sive crustosa in a patient with AIDS. Dermatologist 43: 717-720
  7. Wong SS et al (2005) Unusual laboratory findings in a case of Norwegian scabies provided a clue to diagnosis. J Clin Microbiol 43: 2542-2544

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020