Crusted (Norwegian) scabies induced by use of topical corticosteroids and treated successfully with ivermectin,☆☆

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Abstract

Crusted scabies is mainly observed in children with immunosuppression or mental illness. Treatment is very difficult, and relapse is frequent after topical scabicidal therapy. We describe a case of crusted scabies, induced by long-term application of a topical corticosteroid, relapsing after topical treatment and dramatically improved by ivermectin. We suggest that ivermectin is a safe and effective alternative therapy for the treatment of severe Sarcoptes scabiei infestation in children unresponsive to conventional treatment. (J Pediatr 1999;135:122-4)

Section snippets

CASE REPORT

A 2-year-old boy, with an unremarkable medical history, was admitted to our hospital because of generalized pruritic skin lesions. Five months earlier, pruritic papular lesions were noted first on the axillae, wrists, and thighs, which spread to the legs, abdomen, and thorax. A misdiagnosis of generalized eczema was made, and the young patient was treated with a corticosteroid ointment. During 6 weeks he received a total of 240 mg of betamethasone dipropionate topically. The intense pruritus

DISCUSSION

Crusted scabies is a rare manifestation of Sarcoptes scabiei infestation, mainly observed in patients with immunodeficiency such as that caused by acquired immunodeficiency syndrome, leukemia, human T-lymphotrophic virus-1 infection, and systemic immunosuppressant therapies2, 3, 4, 5, 6; with neuropsychologic impairment such as senile dementia, sensory neuropathy, and Down syndrome and other causes of mental retardation; or with debilitating illness such as malnutrition. In contrast to common

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    Several risk factors predispose institutionalized individuals to scabies and subsequent outbreaks. In health care and residential care facilities, index patients are more likely to be immunosuppressed through iatrogenic means or because of immunosenescence.13-137 Crusted scabies is also associated with institutional outbreaks and was reported in 83% of index cases in 1 study.138

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