Gianotti-Crosti syndrome mimicking scabies.

This case report highlights a case of a 65-year-old woman who presented to our clinic with suspicion of refractory scabies. She had undergone multiple treatments without improvement. However, the clinical condition was not scabies but rather Gianotti-Crosti Syndrome (GCS), leading to rapid clinical improvement and avoiding the need for further unnecessary tests and treatments. GCS is a postviral exanthem characterized by symmetrical, red papules on the extremities and buttocks, typically occurring in children but can also affect adults. It is crucial for every physician to distinguish it from other causes of rash, including scabies, to ensure an accurate diagnosis and appropriate management.

Scabies in infants and children - a narrative review.

Scabies is a human ectoparasitosis caused by Sarcoptes scabei var. hominis. World-wide around 300 million patients are affected. Infants and children have the highest incidence rates. Poverty and overcrowding are social factors contributing to a higher risk of transmission and treatment failure. The leading symptom of the infestation is itch. Complications are bacterial infections that are responsible for mortality. Diagnosis is clinical. Non-invasive imaging technologies like dermoscopy can be used. Polymerase chain reaction (PCR) is less sensitive and specific than microscopy of skin scrapings. Treatment of choice is topical permethrin 5%. Ivermectin is the only oral drug FDA-approved for scabies. It should be used in cases non-responsive to topical therapy and in case of high number of infested patients in addition to topical therapy. Pseudo-resistance to treatment is not uncommon. New drugs are on the horizon. What is Known: • Pruritus is the leading symptom causing sleep disturbances and scratching with the risk of secondary bacterial infections. • Treatment failure is related to inappropriate application of topical drugs and asymptomatic family members. What is New: • COVID-19 pandemic and migration are contributing to an increased incidence of scabies. • New compounds to treat scabies are on the horizon.

Plantar keratoderma-like crusted scabies in an immunocompetent infant after topical steroids.

A healthy 6-month-old girl presented with plantar keratoderma-like lesions unresponsive to topical corticosteroids. Nocturnal pruritus in 13 relatives, presence of burrows on clinical exam, and the positive scabies preparation led to the diagnosis of crusted scabies. She was successfully treated with topical and oral scabicides. Crusted scabies is a severe form of Sarcoptes scabiei infection uncommon in immunocompetent subjects, in whom previous corticosteroid use may favor its occurrence.

SARCOPTIC MANGE IN FREE-RANGING NORTH AMERICAN PORCUPINES (ERETHIZON DORSATUM) IN NEW YORK STATE.

Sarcoptic mange causes pruritic and crusting dermatitis in a large number of mammalian species with varying population impacts. Between 2016 and 2022, 15 North American porcupines (Erethizon dorsatum) were diagnosed with sarcoptic mange at Cornell University's Janet L. Swanson Wildlife Hospital in Ithaca, New York. Disease severity varied among individuals but all shared a similar unique presentation with thick, pale tan to yellow crusts limited in distribution to the ventral, nonquilled areas of the body, including the ventral abdomen and thorax, distal limbs, and face. The thick, hard nature of the crusts resulted in additional complications in many individuals, including inability to move the jaw and cracking and fissuring of the crusts and skin over joints of the limbs. Mites were plentiful within the crusts, with some burrowing into the epidermis as deep as the stratum spinosum. Secondary bacterial and/or fungal dermatitis were common, resulting in sepsis and death in three of the porcupines. Treatment with avermectins (ivermectin and/or selamectin) for 4-5 wk was successful in 12 cases in combination with other supportive care measures, including subcutaneous fluids, antimicrobials, and analgesics. Porcupines were hospitalized for an average of 18 d (ranging from 7 to 50 d) prior to transfer to a licensed wildlife rehabilitator for continued treatment and eventual release back into the wild.

[Translated article] Clinical and Epidemiological Characteristics of Patients Being Treated for Scabies in Spain: Opportunities for Improvement - A Multicenter Cross-Sectional CLINI-AEDV Study.

BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had clinical features of classic scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of scabies cases, the patient has already received treatment. In those cases, we observe several remediable shortcomings that could explain why some of these treatments fail. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

Case of concurrence of bullous pemphigoid and Norwegian scabies.

Bullous pemphigoid (BP) with scabies is a condition rarely encountered in clinical practice, and when it is encountered, it is often due to the use of immunosuppressants. This paper is a report on a patient with BP and scabies, who developed scabs after taking dexamethasone. It should be noted that BP antibody is necessary, which can distinguish BP with scabies and bullous scabies, and the treatment options for the two diseases are different.

Optical microscopic study on a novel morphological classification method of multiple diagnostic features of Sarcoptes scabiei var. hominis.

Optical microscopy is the gold standard technique used to confirm the diagnosis of scabies. Multiple diagnostic features of the pathogen Sarcoptes scabiei var. hominis (S. scabiei) can be identified under a microscope and classified into 3 categories: mites, eggs and fecal pellets. However, mite and eggshell fragments can also be observed, which have been ignored in the 2020 International Alliance for the Control of Scabies (IACS) Criteria and by most researchers. In this study, we propose a novel morphological classification method that classifies multiple diagnostic features into 5 categories and 7 subcategories. Our results revealed that 65.2% (1893 of 2896) of the positive cases were confirmed through the identification of mites, eggs or fecal pellets, whereas up to 34.6% (1003 of 2896) of the positive cases were confirmed through the identification of mite or eggshell fragments. Therefore, the important diagnostic values of mite and eggshell fragments should be emphasized. Importantly, for the first time, mite and eggshell fragments were classified into 7 subcategories, some of which are easily ignored or confused with contaminating artefacts. We believe that this novel morphological classification method will be beneficial for operator training in interpreting slides and in improving the 2020 IACS Criteria.

Severe Scabies: A French Multi-centre Study Involving 95 Patients with Crusted and Profuse Disease and Review of the Literature.

The aim of this multi-centre French retrospective study was to identify severe, i.e. crusted and profuse, scabies patients. Records were retrieved from 22 Dermatology or Infectious Diseases departments in the Ile-de-France from January 2009 to January 2015 to characterize epidemiology, demography, diagnosis, contributing factors, treatment features, and outcomes in severe scabies. A total of 95 inpatients (57 crusted and 38 profuse) were included. A higher number of cases was observed among elderly patients (>75 years), mostly living in institutions. Thirteen patients (13.6%) reported a history of previously treated scabies. Sixty-three patients (66.3%) had been seen by a previous practitioner for the current episode (up to 8 previous visits). Initial misdiagnosis (e.g. eczema, prurigo, drug-related eruptions, psoriasis) was documented in 41 patients (43.1%). Fifty-eight patients (61%) had already received 1 or more previous treatments for their current episode. Forty percent received corticosteroids or acitretin for an initial diagnosis of eczema or psoriasis. Median time from the onset of symptoms to the diagnosis of severe scabies was 3 months (range 0.3-22). Itch was present in all patients at diagnosis. Most patients (n=84, 88.4%) had comorbidities. Diagnostic and therapeutic approaches varied. Complications occurred in 11.5% of cases. To date, there is no consensus for diagnosis and treatment, and future standardization of is required for optimal management.

Standardized cotton swab sampling with nested quantitative polymerase chain reaction is effective for diagnosing ordinary scabies.

BACKGROUND: Low sensitivity of the PCR assay for diagnosing scabies has been noted because of the difficulty in obtaining tissue containing Sarcoptes scabiei DNA. AIM: To evaluate nested real-time quantitative PCR (nRT-qPCR) with nonexpert-dependent standardized cotton swab sampling (CSW) as a tool for diagnosing scabies. METHODS: All patients underwent dermoscopic and microscopic examination (MS) with scraped sampling (Sc). Patient samples were acquired with a single, dry swab rubbed across the flexor areas of both wrists as well as the eight interdigital spaces and on any suspected scabies lesions. nRT-qPCRs were performed with Sc and CSW samples. RESULTS: Out of 125 patients with suspected scabies, 120 patients were sampled, and 57 were positive (positive with: MS n = 53; nRT-qPCR with Sc n = 52; nRT-qPCR with CSW n = 46) and 63 were negative for scabies. The sensitivities of these tests were 93.0%, 91.2% and 80.7%, respectively, which were not different statistically (P > 0.05). However, upon subsequent monitoring after treatment, the sensitivity of nRT-qPCR with CSW was only 36.6%, which was significantly lower than 83.0% for MS and 92.7% for nRT-qPCR with Sc (P < 0.001). The obtained sequences showed 97%-100% homology with scabies sequences deposited in GenBank. CONCLUSION: CSW with nRT-qPCR shows sensitivity close to MS with scraping performed by experts for diagnosing scabies in an outpatient setting, but not for post-treatment monitoring. CSW with nRT-qPCR may be useful for physicians unfamiliar with a traditional diagnostic method, and for screening an outbreak in community facilities.

Children's scabies survey indicates high prevalence and misdiagnosis in Auckland educational institutions.

AIM: Here, we present results of a survey of scabies prevalence in childcare centres and primary schools in Auckland. METHODS: Children whose parents agreed to take part in participating centres in the Auckland region were examined for scabies by general practitioners and given questionnaires of relevant symptoms. Diagnoses of clinical or suspected scabies were made according to the International Alliance for the Control of Scabies (IACS) criteria. The survey was a stratified random sample of schools and early childcare centres. A quantitative polymerase chain reaction (PCR) test was also used to complement the IACS criteria. RESULTS: A total of 181 children were examined, with 145 children with history information, 16 of whom (11.0%) met the criteria for 'clinical' or 'suspected' scabies. Weighted analysis, accounting for the survey design, indicated that the prevalence of scabies in early childcare centres was 13.2% (95% CI: 4.3 to 22.1), with no school-aged children fulfilling these criteria. A higher proportion had clinical signs of scabies with 23 (12.7%) having typical scabies lesions and a further 43 (23.8%) had atypical lesions. A total of 64 PCR tests were taken and 15 (23%) were positive. None of these cases were receiving treatment for scabies. Five were undergoing topical skin treatment: three with topical steroid and two with calamine lotion. CONCLUSIONS: The prevalence of children with scabies is high in early childcare centres in Auckland. Misdiagnosis is suggested by several PCR positive cases being treated by topical agents used to treat other skin conditions.

Delusions of parasitosis and delusions of parasitosis by proxy in a mother and her children.

Delusions of parasitosis by proxy is an uncommon entity wherein an individual projects a delusional belief onto another person who lacks capacity to hold the same belief. We report a case of delusions of parasitosis by proxy in a mother who believed that she was infested with scabies and projected her fixed, delusional belief of scabies infestation onto her children. She subjected her children to numerous home remedies and medical treatments as well as removing them from school in an effort to cure them of the supposed infestation. Child maltreatment can be a concern in such cases with a low threshold for involving child protective services if harm to the children is suspected.

Scabies: an update for community nurses.

Community nurses may encounter scabies in homeless people, those living in prisons, people living at home or in people living in care homes. Scabies is more prevalent in older adults and there is evidence that this infection is becoming more prevalent and difficult to treat. The community nurse can help reduce such risks. This article aims to enable the community nurse to be aware of the clinical features of scabies and how it is treated.

Comparison of sulfur ointment and permethrin treatments in scabies.

Scabies is a contagious, parasitic skin disease that adversely affects the quality of life and, can cause systemic complications if it is not properly treated. Sulfur ointment and permethrin cream are among the most used topical agents in the treatment of scabies. In this study, we aimed to compare the efficacy of sulfur ointment and permethrin cream in the treatment of scabies. In this single-center study, patients who were diagnosed with scabies in the dermatology outpatient clinics of Karabuk University Training and Research Hospital between April, 2021 and September, 2021 were investigated retrospectively. Age, gender, date of diagnosis, topical agent used for scabies treatment, and response to the treatment at the control examination in the second week were recorded. The patients were divided into two groups those receiving 5% permethrin cream or 10% sulfur ointment, and the treatment efficacy of both agents was compared. This study showed that 10% sulfur ointment was significantly more effective in treating scabies than 5% permethrin cream (p < 0.001). Moreover, younger patients with scabies responded better to both treatments. 10% Sulfur ointment can be considered a safe and effective topical option in the treatment of scabies. The resistance to 5% permethrin cream, which is the most commonly used agent for scabies, can be a concern as an unexpected low success rate was obtained in this study.

Can we increase the success of scabies treatment? The effect of removing tunnels from patients in the success of scabies treatment.

Recently, there has been an increase in scabies infestations. Moreover, the number of patients who do not benefit from conventional treatment regimens is increasing rapidly worldwide. This situation leads clinicians to seek new treatments. To evaluate the contribution of mechanical parasite removal to treatment success when applied prior to topical permethrin 5% treatment. The mechanical removal process was applied once during diagnosis. Two groups of 30 people each were included in the study. Permethrin treatment was given directly to the first group without any procedure. In the second group, the maximum number of tunnels that could be detected were removed from patients. After this procedure, the group received permethrin treatment. All patients were called for control after 10 days, and treatment response rates were evaluated. Sixteen (53.3%) patients who received permethrin treatment directly without any procedure responded to the treatment. In the remaining 14 (46.6%) patients, tunnels and Sarcoptes mites were still present. In the second group, which underwent tunnel removal, complete recovery was observed in 26 (86.6%) patients. The patients who did not benefit from the treatment in the study group had relatively less tunnel removal from their bodies. Removing the tunnel from the patient before the treatment increases the success of the treatment. Considering that there are 8-10 parasites on average in scabies patients, it has been determined that the tunnel removal method is not difficult and contributes to therapeutic success.

Crusted scabies in children in France: a series of 20 cases.

To evaluate the risk factors for crusted scabies in children in France. The retrospective multicenter study, conducted in France, of children (aged < 18 years) with profuse and/or crusted scabies confirmed by dermoscopy and/or microscopy. Data were obtained using a standardized questionnaire. We included 20 children. The mean age was 4.5 years, and 70% of the patients were girls. Their medical history revealed a neurological pathology (agenesis of the corpus callosum; n = 1, 5.0%), prematurity (n = 1, 5.0%), Down syndrome (n = 1, 5.0%), atopic dermatitis (n = 2, 10%), and asthma (n = 2, 10.0%). Fifteen (75.0%) children were treated with steroids before being diagnosed with scabies: 12 (60.0%) with topical steroids, one (5.0%) with a systemic steroid, and two (10.0%) with inhaled steroids. One child (5.0%) lived in a precarious environment. The mean duration of pruritus was 3.4 months, and that of the skin lesions was 3.1 months. The most commonly affected areas for crusted scabies were the palms/hands (66.7%) and the armpits (33.3%). Thirteen children (65.0%) were hospitalized, 14 (70.0%) were treated with ivermectin and all received topical treatments; 85.7% were cured within an average of 38 days, but one child had a relapse 3 months later in the form of common scabies.Conclusion: The main risk factor for developing crusted scabies in France was the misdiagnosis and the use of corticosteroids, especially topical forms typically used in "healthy" children. Management of the children was effective and similar to that used in adults. What is Known: • Crusted scabies is an extremely contagious disease which is rarely reported in infancy, especially in healthy children. • The main risk factors include immunosuppression, physical debilitation, and intellectual disability. What is New: • The main risk factor of severe scabies in this study was delayed diagnosis associated with the use of topical or systemic corticosteroids. • The treatment was successful in 85.7% of cases, and 65% of children needed to be hospitalized.

Direct microscopy in the dermatology clinic: enhancing the management of skin infections and infestations.

Direct microscopy is a valuable skill in the management of skin infections and infestations, yet it is underutilized in dermatology clinics. This review details its use in identifying fungal skin infections and scabies infestations, outlining the steps involved in sample collection, preparation and interpretation.

Bullous Pemphigoid and Scabies: Is There an Association?

BACKGROUND: Bullous Pemphigoid (BP) is an autoimmune subepithelial bullous disease. Several reports suggested an association between BP and scabies. OBJECTIVE: We aimed to evaluate whether an association between BP and scabies exists. METHODS: This is a retrospective matched case-control study. We retrospectively identified BP patients treated in our clinic between January 1, 2009, and December 31, 2016. Each patient was assigned to 3 control subjects (matched by age and sex) treated in our clinic, not due to BP. The study group was examined for a scabies diagnosis within the 3 years prior to BP diagnosis; the control group was examined for a scabies diagnosis 3 years prior to its first visit in our clinic. RESULTS: Fifteen out of the 87 (17.2%) BP patients were diagnosed with scabies within the 3 years prior to their initial BP diagnosis, compared to only 4.2% (11 out of 261) among the control group. The odds ratio of scabies history was 4 times higher among BP patients compared to the control group (OR=4.23; 95% CI: 1.50–11.91, P=0.007). LIMITATIONS: A retrospective study design. CONCLUSIONS: An association between scabies diagnosis and BP is demonstrated in our study. J Drugs Dermatol. 2022;21(9):1009-1011. doi:10.36849/JDD.4900.

Scabies in a 14-year-old girl with superficial epidermolytic ichthyosis.

A 14-year-old girl who reported generalized scaling and hyperkeratosis since age 1 year presented with severe pruritus of several months' duration. Scabies mites were detected, and molecular genetic analysis subsequently revealed a rare pathogenic variant in the keratin 2 (KRT2) gene, confirming a diagnosis of superficial epidermolytic ichthyosis. Treatment with oral ivermectin led to complete remission of symptoms. Disorders of keratinization can mimic clinical signs of scabies, leading to a delay in diagnosis.

Occurrence of sarcoptic mange in free-ranging vicuñas (Vicugna vicugna) of the Andean high plateau region of Argentina.

Free-ranging vicuñas (Vicugna vicugna) are handled in some areas of the Andean high plateau region following an ancestral practice known as chaku, which consists in their transient capture and shearing of their fiber for commercialization. In this study, 807 vicuñas captured during 12 chaku events that took place in 2019 in the province of Jujuy, Argentina, were examined for typical mange skin lesions. Twenty-eight of the examined vicuñas presented alopecia with erythema, exudation, hyperkeratosis, and/or bleeding scarred lesions, mostly in the chest, rear and front legs, and inguinal zone. Most of the cases (82%) appeared in Laguna Cucho at 4900 masl, where 23% of the animals presented these skin reactions. Microscopic evaluation of skin scrapings revealed the presence of a great number of 0.1- to 0.4-mm-long mites of different life cycle stages, morphologically compatible with the species Sarcoptes scabiei. This etiological agent was confirmed by PCR amplification and sequencing of a cox-1 species-specific segment. Histopathological examination of skin biopsies showed extensive infiltration of the dermis with lymphocytes, neutrophils and eosinophils, hyperplasia at different stages, epidermis degeneration, and hyperkeratosis. This is the first characterization of sarcoptic mange in free-ranging vicuñas by clinical examination, mite morphology, histopathological studies, and molecular confirmation in the region. Mange hampers the welfare of vicuñas and the economy of the local communities that organize chaku events since infested vicuñas cannot be sheared. Its long-term effects are unknown but it might affect the fitness and survival of this iconic South American camelid.

The use of dermoscopy to support the diagnosis of sarcoptic mange in two dogs.

Two unrelated adult dogs presenting with chronic pruritic dermatitis were diagnosed with sarcoptic mange through the in vivo dermoscopic visualisation of Sarcoptes scabiei mites. The species of mite was confirmed via microscopy of superficial skin scrapings taken from lesional skin. Dermoscopy offers rapid point-of-care, noninvasive screening for dogs with sarcoptic mange.

Deux chiens adultes non apparentés présentant une dermatite prurigineuse chronique ont été diagnostiqués avec une gale sarcoptique par la visualisation dermoscopique in vivo d'acariens Sarcoptes scabiei. L'espèce d'acarien a été confirmée par microscopie de raclages cutanés superficiels prélevés sur la peau lésionnelle. La dermoscopie offre un dépistage rapide et non invasif au chevet du patient pour les chiens atteints de gale sarcoptique.

Dois cães adultos apresentando dermatite pruriginosa crônica foram diagnosticados com sarna sarcóptica através da visualização dermatoscópica in vivo dos ácaros Sarcoptes scabiei. A espécie de ácaro foi confirmada por avaliação microscópica de raspados cutâneos superficiais coletados de pele lesional. A dermatoscopia é um método diagnóstico que oferece triagem ambulatorial rápida e não invasiva para cães com sarna sarcóptica.

Dos perros adultos no relacionados que presentaban dermatitis pruriginosa crónica fueron diagnosticados con sarna sarcóptica a través de la visualización dermatoscópica in vivo de los ácaros Sarcoptes scabiei. La especie de ácaro se confirmó mediante microscopía de raspados cutáneos superficiales tomados de la piel lesionada. La dermatoscopia ofrece una detección rápida y no invasiva en el punto de atención primaria para perros con sarna sarcóptica.