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Case Reports
. 2023 Mar 11:16:153-158.
doi: 10.2147/IMCRJ.S396234. eCollection 2023.

Combination of Crusted Scabies with Bullous Scabies: A Rare Case

Vella Asnawi  1   2 , Mimi Maulida  1   2 , Arie Hidayati  1   2 , Hendra Gunawan  3   4 , Reiva Farah Dwiyana  3   4 , Reti Hindritiani  3   4
Affiliations
Case Reports

Combination of Crusted Scabies with Bullous Scabies: A Rare Case

Vella Asnawi et al. Int Med Case Rep J. .

Abstract

Scabies is a parasitic skin disease caused by Sarcoptes scabiei var. hominis. Crusted scabies, also known as Norwegian scabies, is a rare and severe form of scabies that occurs more frequently in immunocompromised, elderly, disabled, and debilitated patients. The present study reports a case of crusted scabies combined with bullous scabies. A 44-year-old man was admitted with the chief complaint of red, thick, scaly patches of skin accompanied by crusting that felt itchy and worsened at night. The lesions had appeared all over his body intermittently for the last 10 years; however, the complaints worsened in the last 2 months. From dermatological status, the anterior and posterior thoracic regions and between the fingers of both hands showed generalized distribution of erythematous, yellowish, hyperkeratotic plaques with clear boundaries, pustules, and blisters on an erythematous base with multiple erosions and excoriations. S. scabiei were found on skin scraping examination, and histopathological examination supported the diagnosis of bullous scabies. The patient received 5% permethrin lotion topical therapy and systemic ivermectin therapy. In addition, the patient was given systemic antibiotics. The lesions improved after 2 weeks of therapy, and no S. scabiei were found on the subsequent microscopic examination. Treatment with a combination of topical and systemic scabicidal agents produced a favorable outcome in this patient.

Keywords: Norwegian scabies; Sarcoptes; bullous; ivermectin; permethrin.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Clinical presentation of patient when admitted to the hospital (November 8, 2021).
Figure 2
Figure 2
Result of skin scrapping examination. Skin scrapping showed Sarcoptes scabiei (November 8, 2021 and November 17, 2021) and No Sarcoptes scabiei was seen at skin scrapping (November 23, 2021).
Figure 3
Figure 3
Histopathological result showed subepidermal blister with lymphocytes infiltration in fibromyxoid tissue.
Figure 4
Figure 4
Result of pus culture showed Kocuria kristinae colony.
Figure 5
Figure 5
Clinical presentation of patient after 8 days of hospitalization (November 17, 2021).
Figure 6
Figure 6
Clinical presentation of patient after 15 days of hospitalization (November 23, 2021).
See this image and copyright information in PMC

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