Case Report: Bullous Scabies in Two Children below 10 Years.

Bullous scabies is an infrequent and atypical presentation of scabies, with predilection for elderly and males. Its median age of presentation is 70 years. We report two male cases of bullous scabies who were 7 years and 6 months old. Both patients had excellent response to sulfur 10% ointment alone and have had no recurrence in more than 3 months of follow-up.

Bullous Scabies.

Scabies is a common contagious cutaneous disease and usually affects the young, characterized by polymorphous lesions that may present as burrows, pruritic papules, and inflammatory nodules. Bullous scabies (BS) is its rather rare subtype, mimicking bullous pemphigoid. We report a 15-year-old Chinese boy presenting with 1-month history of pruritic bullae on his penile skin, showing poor response to both topical steroids and systemic antihistamines, but cured by sulfur ointment alone. No recurrence occurred in the 5 years of follow-up. We also reviewed the published cases. Up to date, 44 cases, including the present, have been reported. Of them, 30 were male and 14 were female. The age range was from 1 to 89 years old, with a median age of 70.6 years. The bullous lesions may involve the arms, legs, trunk, genitals, feet, buttocks, thighs, neck, inguinal folds, and may even be generalized. Trunk and extremities are the most common involved locations. Facial or mucosa involvement had never been reported. The histological findings present as a subepidermal split with variable inflammatory infiltrate predominantly neutrophils, and eosinophilic spongiosis, or both. Eighteen of 32 patients showed positive deposition of linear-granular IgG or complement 3 alone or in various combinations, and five of 24 patients revealed circulating IgG. All the 40 cases with therapeutic details were cured by antiscabietic remedy. BS always involves the trunk and extremities. It has a predilection for elderlies and males. The treatments for BS are similar to those of classical scabies.

[Blister beetle dermatitis: Dermatitis linearis]. / Blasenkäfer-Dermatitis: Dermatitis linearis.

Several families of beetles cause toxic reactions on exposed human skin. Cantharidin provokes nearly asymptomatic vesicles and blisters, while pederin leads to itching and burning erythema with vesicles and small pustules, later crusts. Paederi are attracted by fluorescent light especially after rain showers and cause outbreaks in regions with moderate climate. Clinical findings and patient history lead to the diagnosis: dermatitis linearis.

Recurrent bullous scabies.

BACKGROUND: scabies is a common infestation that usually presents as a pruriginous eruption consisting of erythematous papules, nodules, and excoriations. Diagnosis relies mostly on clinical features, including the identification of scabietic burrows. Several atypical clinical manifestations have been reported; bullous presentations are particularly rare and intriguing. OBJECTIVE: a case of recurrent bullous scabies is reported. METHODS AND RESULTS: an 87-year-old institutionalized woman developed a pruriginous eruption that mimicked bullous pemphigoid. Histopathologic examination revealed blistering at the subepidermal level and a mixed inflammatory infiltrate with numerous eosinophils. Scabies mites were identified on dermoscopy and on skin scrapings, allowing a diagnosis of bullous scabies. Despite effective treatment with topical lindane, failure to control scabies in her institution led to recurrences of her peculiar blistering infestation. Immunofluorescence studies were always negative. CONCLUSIONS: these observations underscore the mite's role in the pathogenesis of blister formation and illustrate current challenges in scabies' diagnosis and management.

Outbreak of rove beetle (Staphylinid) pustular contact dermatitis in Pakistan among deployed U.S. personnel.

Deployed military personnel are often faced with a variety of exposures unfamiliar to U.S. physicians. This is the first report to describe an outbreak of a pustular disease among U.S. personnel deployed to Pakistan in support of Operation Enduring Freedom. Up to 10% of the base population was afflicted with a pustular eruption and an accompanying halo of erythema. A retrospective chart review and ongoing patient care resulted in 191 cases. Various therapies were used, including "watchful waiting." Gradual resolution occurred with residual area(s) of hypo- or hyperpigmentation. An irritant contact dermatitis was suspected based upon clinical presentation; staphylinid (rove) beetles were implicated. Rove beetle dermatitis from a pederin toxin has occurred in other parts of the world but has not been previously reported in Pakistan. We discuss the nature and progression of the dermatitis, treatments, outcomes, measures to control exposures, and the implications of such outbreaks.

Induction of protective immunity in rabbits by coadministration of inactivated Pasteurella multocida toxin and potassium thiocyanate extract.

Pasteurella multocida is a bacterial pathogen that causes rhinitis (snuffles), pneumonia, otitis media, septicemia, metritis, and death in domestic rabbits. Currently, there are no effective vaccines to prevent infection by this organism. Subcutaneous (s.c.) immunization with either exotoxin or thiocyanate extracts of P. multocida induces partial protection in rabbits. Since disease begins at mucosal sites, induction of local immunity may be important in preventing systemic disease. Little is known concerning the efficacy of intranasal (i.n. ) administration of these antigens in inducing protective mucosal immunity to P. multocida in rabbits. The purpose of this study was twofold: (i) to investigate the effectiveness of vaccination with purified P. multocida toxin (PMT) and a potassium thiocyanate extract of P. multocida (CN) in combination and (ii) to evaluate the efficacy of administration of these antigens i.n. versus s.c. Forty-eight rabbits were randomly divided into eight different treatment groups. Rabbits received either one or both antigens by either s.c. or i.n. administration. Following vaccination, each group received an i.n. challenge of P. multocida. Rabbits vaccinated with both antigens i.n. or s.c. had a 100% survival rate, few or no bacteria in the liver and lungs, high serum immunoglobulin G (IgG) and IgM antibody titers, and significant numbers of IgG antibody-secreting cells (ASC) in the spleen and tracheobronchial lymph node. Rabbits vaccinated i.n. had significant nasal and bronchoalveolar lavage IgA antibody levels. Rabbits vaccinated with only one antigen, either PMT or CN, had lower antibody titers, moderate to severe liver and lung infections, and fewer ASC compared to rabbits receiving both antigens. Rabbits in the control groups had moderate to severe liver and lung infections. This study indicates that i.n. immunization with both PMT and CN induces an effective response against homologous P. multocida challenge.