Norwegian scabies in a patient treated with Tripterygium glycoside for rheumatoid arthritis.

We report an 80-year-old male patient with severe rheumatoid arthritis who was treated with tripterygium glycoside, an immunosuppressive agent made from the extract of a Chinese medicinal herb called Tripterygium wilfordii Hook F. The patient had no apparent skin lesions before the treatment, but he developed aggressive hyperkeratotic lesions with rapid progression after using tripterygium glycoside. He was repeatedly diagnosed with eczema, but treatment failed to achieve efficacy. Interestingly, a microscopic examination of the lesions revealed numerous scabies mites and eggs. Thus, we confirmed the diagnosis of Norwegian scabies infection. Treated with crotamiton 10% cream and 10% sulfur ointment for one month, the patient's clinical symptoms disappeared.

Norwegian scabies in a patient treated with Tripterygium glycoside for rheumatoid arthritis

Abstract: We report an 80-year-old male patient with severe rheumatoid arthritis who was treated with tripterygium glycoside, an immunosuppressive agent made from the extract of a Chinese medicinal herb called Tripterygium wilfordii Hook F. The patient had no apparent skin lesions before the treatment, but he developed aggressive hyperkeratotic lesions with rapid progression after using tripterygium glycoside. He was repeatedly diagnosed with eczema, but treatment failed to achieve efficacy. Interestingly, a microscopic examination of the lesions revealed numerous scabies mites and eggs. Thus, we confirmed the diagnosis of Norwegian scabies infection. Treated with crotamiton 10% cream and 10% sulfur ointment for one month, the patient's clinical symptoms disappeared.

[Crusted scabies induced by topical corticosteroids: A case report]. / Gale hyperkératosique favorisée par l'utilisation de dermocorticoïdes : à propos d'un cas.

The frequency of scabies is increasing in France. Crusted (or Norwegian) scabies is a very contagious form of scabies because of the huge number of mites in the skin. It is observed in patients suffering from immunodepression, motor or sensory deficiency, or mental retardation. The clinical presentation, except for the classic manifestation of scabies, is characterized by crusted lesions. Treatment is not easy and requires hospitalization. Topical corticosteroids are frequently used for children's dermatological diseases. Their long-term and inappropriate application in an infested scabies child can induce crusted scabies. We report on a case of an 8-year-old boy who developed crusted scabies induced by topical corticosteroid application. We discuss the therapeutic aspects of this severe form of scabies.

Crusted Norwegian scabies, an opportunistic infection, with tocilizumab in rheumatoid arthritis.

BACKGROUND: Crusted Norwegian scabies is an extremely rare hyperkeratotic variant of scabies infestation. We report herein a case of crusted scabies in a woman with severe rheumatoid arthritis (RA) treated by tocilizumab (TCZ), a monoclonal antibody blocking the interleukin-6 receptor. OBSERVATION: An 80-year-old female with severe RA developed erythroderma followed by hyperkeratosis, widespread scaling over the trunk, arms, hands and limbs, and crusted lesions on her scalp. She was on TCZ (8 mg/kg per month) with prednisone (20 mg/d). Several hypotheses were evoked (i.e., vasculitis, psoriasis or paraneoplasic syndrome) but a microscopic examination of the skin surprisingly demonstrated numerous scabies mites and eggs leading to the diagnosis of crusted (Norwegian) scabies. After repeated use of ivermectin and application of topical piperonyl butoxide cream, scabies disappeared. However, there had been outbreak of scabies among two individuals in the staff and two patients. TCZ was stopped after four infusions because of a severe infectious pneumonia and failure. CONCLUSION: Crusted scabies should be evoked in case of pruritus or erythroderma occurring under TCZ therapy and it may be explained by the interleukin-6 blockade.

Skin diseases associated with the cosmetic use of bleaching products in women from Dakar, Senegal.

BACKGROUND: The cosmetic use of bleaching products is considered a common practice in dark-skinned women from sub-Saharan Africa. However, there are few studies on this subject. OBJECTIVES: To increase the knowledge about the dermatological consequences of this practice in Dakar, the capital of Senegal. METHODS: A representative sample of 368 adult women presenting at our dermatological centre was selected. Each woman was questioned about her cosmetic use of bleaching products. Next, the following data were recorded in 425 women who used bleaching products: names and types of products used; modalities of the skin bleaching practice; skin diseases motivating the dermatological visit, with recording of their clinical features; and results of a full skin examination. The active substances of the bleaching products were determined mainly by reading the indications on their packages; with products of unknown composition, a pharmacological analysis of samples was done. A statistical analysis was performed. RESULTS: Of the 368 women questioned, 194 (52.7%) were current users of bleaching products. Concerning the 425 users enrolled, products were applied on the whole body in 92% of users, with a median duration of use of 4 years. The active principles used included hydroquinone (used by 89% of users), glucocorticoids (70%), mercury iodide (10%) and caustic agents (17%); 13% of users used products of unknown composition. In the samples that were analysed, hydroquinone was found at concentrations of between 4% and 8.7%. Concerning steroids, superpotent (class 1) glucocorticoids predominated. The main skin complaints in bleaching products users included dermatophyte infections (n = 105) and scabies (n = 69), both often unusually extensive and severe; acne (n = 42), often severe; eczema (n = 41); irritant dermatitis (n = 14); and dyschromia (n = 26, including 14 cases of exogenous ochronosis). The skin examination noted features apparently disregarded by users: striae (noticed in 39% of users), and macular hyperchromia involving the face, mainly the periocular area (33%). The statistical analysis showed that glucocorticoid use was associated with the presence and severity of infectious skin diseases, and of acne. CONCLUSIONS: More than half of the adult women presenting at our dermatology centre were using bleaching products. Most skin diseases observed in bleaching products users appeared to be induced, aggravated or modified by this practice. Superpotent topical glucocorticoids appeared to be the main agents responsible for the observed complications. The cosmetic use of bleaching products therefore has a major impact on our current dermatological practice.

Disseminated scabies evolving in a patient undergoing induction chemotherapy for acute myeloblastic leukaemia.

We report on a 34-year-old refugee from the Balkans presenting with a generalized papular rash during induction chemotherapy for acute myeloblastic leukaemia (AML M4eo). This rash appeared on day 5 of the chemotherapy and was diagnosed as disseminated scabies. It was successfully treated with a combination of oral ivermectin and topical lindane. Scabies disappeared completely despite ongoing neutropenia and other severe infectious complications. Disseminated scabies should be included in the differential diagnosis of rash in severely immunosuppressed patients coming from poor housing conditions.

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

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.

[Steroid-induced scabies norvegica]. / Steroidinduzierte Scabies norvegica.

Two patients aged 50 and 84 years presented with generalized itching eczema that has been treated with external and internal steroids for months. Despite therapy, the condition worsened continuously. Examination of skin scrapings revealed numerous mites, so Norwegian scabies was diagnosed. General examinations excluded underlying diseases. Treatment with steroids over months most likely led via immunosuppression to the exacerbation of the disease.

Sarna Noruega inducida por esteroides tópicos / Norvegian scabies induced by topical steroids

La Sarna Noruega es una forma rara de escabiosis, ubicada en el extremo más severo del espectro de la infestación por el Sarcoptes scabiei. Se estudia una paciente que presenta placas verrugosas, grisáceas en dorso de manos y pies, pezones, pliegues inguinales, axilares y popliteo derecho, de 2 años de evolución, tiempo durante el cual recibó esteroides tópicos como tratamiento

Norwegian scabies developing during treatment with fluorinated steroid therapy.

A fit, normally intelligent young man developed Norwegian scabies after prolonged treatment with large quantities of clobetasol propionate ointment. The development of this overwhelming infestation from the normal eruption of scabies may be related to the local immunosuppressive effect of this potent topical steroid.

Reactivation of scabies rash by methotrexate.

A 13-year-old female was on maintenance therapy for acute lymphoblastic leukemia. On three occasions she received methotrexate orally and each time this was associated with reactivation of scabies rash. The mechanisms for this phenomenon are discussed.