Crusted Scabies

January 28, 2013

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+). Repeated oral doses of ivermectin along with topical permethrin application were required to clear this infestation.

A 40-year-old woman who had been receiving prednisone and 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 along with topical permethrin application were required to clear her infestation.

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