Scabies crustosa B86.x1

Authors: Prof. Dr. med. Peter Altmeyer, Prof. Dr. med. Martina Bacharach-Buhles

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Last updated on: 03.09.2023

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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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Indicator disease in immunosuppression, e.g. in diabetes mellitus, after organ transplantation, leukemia, AIDS, cachexia, after long-term glucocorticoid or cytostatic therapy. Cases of scabies crustosa are also detected in patients who are deprived of 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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No large studies are available on the therapy of Scabies norwegica. Initially, keratolytic pretreatment with 5-10% salicylic acid ointment(e.g., Salicylvaseline Lichtenstein, R228 ) for several days. For antiscabies therapy, permethrin is recommended in the majority of cases because it is easy to handle and well tolerated (regarding practical handling, see below Scabies). Permethrin treatment should be given daily for two weeks, but should be repeated at least once after 1 week.

Ivermectin and/or permethrin should be administered again if signs of active infestation persist after the second therapy (microscopic or dermoscopic evidence of active scabies mites).

Internal therapy
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The use of ivermectin (Driponin® 3 mg tablets; Scabioral®, 0.2mg/kg body weight) p.o. as a single dose, synchronized with external therapy, is recommended. Repeat therapy after 7 to 15 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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