Crusted Scabies Research Articles

Increased Allergic Immune Response toSarcoptes scabieiAntigens in Crusted versus Ordinary Scabies

Scabies, a parasitic skin infestation by the burrowing "itch" mite Sarcoptes scabiei, causes significant health problems for children and adults worldwide. Crusted scabies is a particularly severe form of scabies in which mites multiply into the millions, causing extensive skin crusting. The symptoms and signs of scabies suggest host immunity to the scabies mite, but the specific resistant response in humans remains largely uncharacterized. We used 4 scabies mite recombinant proteins with sequence homology to extensively studied house dust mite allergens to investigate a differential immune response between ordinary scabies and the debilitating crusted form of the disease. Subjects with either disease form showed serum IgE against recombinant S. scabiei cysteine and serine proteases and apolipoprotein, whereas naive subjects showed minimal IgE reactivity. Significantly (P < 0.05) greater serum IgE and IgG4 binding to mite apolipoprotein occurred in subjects with crusted scabies than in those with ordinary scabies. Both subject groups showed strong proliferative responses (peripheral blood mononuclear cells) to the scabies antigens, but the crusted scabies group showed increased secretion of the Th2 cytokines interleukin 5 (IL-5) and IL-13 and decreased Th1 cytokine gamma interferon (IFN-gamma) in response to the active cysteine protease. These data confirm that a nonprotective allergic response occurs in the crusted disease form and demonstrate that clinical severity is associated with differences in the type and magnitude of the antibody and cellular responses to scabies proteins. A quantitative IgE inhibition assay identified IgE immunoreactivity of scabies mite antigens distinct from that of house dust mite antigens, which is potentially important for specific scabies diagnosis and therapy.

Longitudinal Evidence of Increasing In Vitro Tolerance of Scabies Mites to Ivermectin in Scabies-Endemic Communities

Scabies remains a prominent cause of morbidity in remote Aboriginal communities in northern Australia. Secondary bacterial infection of skin lesions caused by scabies is linked to high rates of rheumatic fever and rheumatic heart disease in affected communities.1 Because the sustainability of community scabies eradication programs using topical permethrin, 5%, is problematic, oral ivermectin has been proposed as an alternative acaricide for mass drug administration. While ivermectin is used routinely for the management of crusted scabies (CS) in northern Australia, reports of clinical and in vitro resistance2 indicate that prospective monitoring is required to detect the further emergence of ivermectin resistance. Herein, we report the results of a longitudinal study of in vitro acaricide sensitivity of Sarcoptes scabiei to ivermectin in a region under increasing drug selection pressure.

Diagnostic Dilemma: Crusted Scabies Superimposed on Psoriatic Erythroderma in a Patient With Acquired Immunodeficiency Syndrome

A 45-year-old man with AIDS presented with extensive erythema and scaling involving the face, trunk, and upper and lower extremities, and mild nail dystrophy. The patient had been diagnosed with psoriasis 2 years previously, and at the time of presentation was using emollients and topical corticosteroid creams with little improvement. He was receiving zidovudine, lamivudine, trimethoprim/sulfamethoxazole, acyclovir, rifabutin, and hydroxyzine. Pertinent laboratory data included CD4 lymphocytes (10 cells/mm(3)), viral load (32,000 copies per mL) white blood cell count (3.4 x 10(3)/microL), hemoglobin (13.5 g/dL), and platelets (204 x 10(3)/microL). Because of the extensive eruption and lack of response to topical agents, the patient was started on acitretin 25 mg daily. The patient had shown no signs of improvement 4 weeks later and was noted to have brownish gray crusted plaques involving the beard area, neck, upper part of the back, arms, trunk, genitals, and thighs in addition to his erythroderma (Figure 1 and Figure 2). Microscopic examination of scales from the upper part of the back revealed numerous scabies mites and eggs. He was then treated with lindane shampoo on the scalp and beard area and permethrin 5% cream to the body. The patient returned 2 weeks later with some improvement after thrice-weekly applications of this regimen; however, scrapings from the trunk once again revealed live scabies mites. Microscopic examination of scales that had fallen on the examination table revealed multiple mites and eggs. The patient was then given permethrin 5% cream, which he applied 3 times a week for 2 weeks, and 1 dose of oral ivermectin, 200 micro/kg. This resulted in a marked decrease in crusting and scaling. With resolution of the scabies lesions, the patient displayed marked erythema and scaling of the trunk and extremities consistent with generalized psoriasis (Figure 3). Treatment with acitretin resulted in gradual resolution of the erythroderma. A few months later, the patient presented with nodules on the upper part of the back, which on biopsy revealed a scabies mite (Figure 4).

PIMECROLIMUS RELATED CRUSTED SCABIES IN AN INFANT

Pediatric DermatologyVolume 23, Issue 3 p. 299-300 PIMECROLIMUS RELATED CRUSTED SCABIES IN AN INFANT RAMÓN RUIZ-MALDONADO M.D., RAMÓN RUIZ-MALDONADO M.D. Mexico City, MexicoSearch for more papers by this author RAMÓN RUIZ-MALDONADO M.D., RAMÓN RUIZ-MALDONADO M.D. Mexico City, MexicoSearch for more papers by this author First published: 12 June 2006 https://doi.org/10.1111/j.1525-1470.2006.00241.xCitations: 5 Letters to the Editor are welcome for publication (subject to editing). Letters must be signed by all authors, typewritten double spaced, and must not exceed two pages of text including references. Two copies of all letters should be submitted along with one copy on disk. Letters should not duplicate material submitted or published in other journals. Prepublication proofs will not be provided. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume23, Issue3May 2006Pages 299-300 RelatedInformation

Combination Drug Therapy Is Best for Crusted Scabies

Combination Drug Therapy Is Best for Crusted Scabies

Combo Drug Therapy Is Best for Crusted Scabies

Combo Drug Therapy Is Best for Crusted Scabies

Circulating IgE in patients with ordinary and crusted scabies.

Serum from seven patients with ordinary scabies and six with crusted scabies were screened by immunoblotting for IgE- and IgG-specific proteins in an extract of the mite, Sarcoptes scabiei variety canis. Sera from atopic individuals without sensitivity to house dust mites were used as controls. Serum from all of the patients with crusted scabies showed strong IgE binding to 11-21 and IgG binding to 1-7 scabies proteins. In contrast, three of the seven patients with ordinary scabies showed IgE binding to one to six scabies proteins, and their antibody binding was much weaker. Patients with crusted scabies had serum antibody that reacted with larger molecular weight proteins compared with patients with ordinary scabies. The results of this study indicate that patients with crusted scabies showed a pronounced IgE response to scabies mites, whereas patients with ordinary scabies did not.

Dermatopathology of Caprine Scabies and Protective Immunity in Sensitised Goats Against Sarcoptes scabiei Reinfestation

The purpose of this study was to compare macroscopic dermatopathology in naive and sensitised goats, and to assess protective immunity possessed by sensitised goats against Sarcoptes scabiei challenge. Eighteen goats were allocated evenly into 3 groups; group 1 sensitised with the mite twice, group 2 once and group 3 was not sensitised (naive). Sensitisation was done by infesting goats with the mites on the auricle and infestation was allowed to progress for 7 weeks, then the goats were treated with Ivermectin to obtain complete recovery. After sensitisation, all sensitised and naive goats were infested with the mites on the auricles. Infestation in the sensitised goat caused severe immediate hypersensitivity that resulted in severe peracute pustular dermatitis. After one week, however, the lesion waned slowly. At 7 weeks post infestation, the remnant of lesion could only be perceived by palpation on the primary site of infestation as a mild papular dermatitis. Infestation on the naive goats, in contrast, produced slowly progressing lesions which at 7-week post infestation, it ended up with severe crusted scabies affecting almost the whole skin. Antigens responsible for the immediate hypersensitivity which are supposedly contained in the mite secretions or excretions are immunologically protective but unlikely to have the capacity to induce a complete protection against mite challenge in immunised animals. This notion is based on the fact obtained from this study that goats sensitised twice did not possess a higher immune protection against mite challenge than goats sensitised once. Key words : Sarcoptes scabiei var. caprae , sensitisation, protective immunity, immediate hypersensitive

Ivermectin for Sarcoptes scabiei hyperinfestation

Objectives: Crusted (Norwegian) scabies is an unusual variant of scabies caused by hyperinfestation with Sarcoptes scabiei. It has high morbidity, and secondary bacterial skin sepsis may result in life-threatening bacteremia. An open label study of oral ivermectin was carried out in patients with crusted scabies refractory to topical therapy. Methods: Patients with refractory crusted scabies were prescribed oral ivermectin, one to three doses of 200 μg/kg at 14-day intervals, combined with topical scabicide and keratolytic therapy. Results: Of the 20 patients who received ivermectin, 8 had a complete initial clinical response, a partial response was achieved in 9, and minimal improvement occurred in 3. Three doses of ivermectin were curative for 8 of 10 cases, but recurrence of scabies from presumed reinfestation occurred in at least half of these. Conclusion: The authors conclude that ivermectin is effective for crusted scabies; however, multiple doses may be required to achieve a cure, and recurrence 6 or more weeks after completing treatment is common.

Management of Crusted (Norwegian) Scabies

This paper describes a variant of scabies known as crusted scabies and reviews the range of topical products available to treat patients with typical and crusted scabies infestations. It also discusses clinical studies on the use of oral ivermectin and highlights the approach currently being taken to treat patients with crusted scabies in the Top End of the Northern Territory where the number of people presenting with this condition has increased in recent years.

Critical Commentary

A case of unusual crusted (Norwegian) scabies involving the entire skin of a 26 year old Brazilian patient with lepromatous leprosy is reported. The more prominent histopathological findings were acanthosis, hyperkeratosis and crusting with many mites of Sarcoptes scabiei. In the dermis, numerous foamy histiocytes filled with abundant acid-fast bacilli were seen.

Coexistence of an Unusual Form of Scabies and Lepromatous Leprosy: A Case Report

A case of unusual crusted (Norwegian) scabies involving the entire skin of a 26 year old Brazilian patient with lepromatous leprosy is reported. The more prominent histopathological findings were acanthosis, hyperkeratosis and crusting with many mites of Sarcoptes scabiei. In the dermis, numerous foamy histiocytes filled with abundant acid-fast bacilli were seen.

Ivermectin for Crusted (Norwegian) Scabies

To the Editor: Crusted (Norwegian) scabies is caused by an infestation with Sarcoptes scabiei var. hominis in which the mite population is enormous and may number in the millions. Crusted scabies i...

Localized crusted scabies in the acquired immunodeficiency syndrome

Crusted scabies (CrS) is an uncommon occurrence among patients with AIDS. Indeed to date only five cases have been described, all with widespread lesions. A case of localized CrS appearing as a yellowish and crusted plaque on the second right toe is reported in a woman with AIDS. Scraping off the verrucous surface, as well as punch-biopsy revealed many mites within the horny layer. The infestation is related to the cutaneous immune response and thus CrS should be considered an opportunistic infestation in AIDS. The importance of the early diagnosis of CrS in order to prevent disseminated lesions and involvement of other health-care workers is underlined.

Diabetic Patient With Crusted Plaques

REPORT OF A CASE A 56-year-old woman with a history of diabetes mellitus, hypertension, and chronic renal failure secondary to these conditions presented with presumed seizure activity. She was hospitalized for evaluation. Our department was consulted concerning a severe rash over the thorax and all four extremities (Figs 1 and 2). The patient stated that she had experienced a gradual worsening of her skin condition over a 13-month period. There was no associated pruritus. Her family members had no history of a similar skin problem. Diagnostic procedures were performed, and a skin biopsy specimen is shown in Fig 3. What is your diagnosis? DIAGNOSIS: Crusted (Norwegian) scabies. DISCUSSION Infestation of the mite Sarcoptes scabiei represents the well-known condition called scabies . The females burrow into the stratum corneum to lay eggs. This act usually causes the classic clinical picture of linear burrows in the skin. The typical distribution involves the interdigital spaces of the fingers

Crusted (Norwegian) Scabies With Adult T-Cell Leukemia

Crusted (Norwegian) scabies occurred in a patient with adult T-cell leukemia. It was not noted at the time of hospital admission. Scabies should be included among the opportunistic pathogens in immunocompromised hosts.

On Crusted Scabies

International Journal of DermatologyVolume 24, Issue 1 p. 292-292 On Crusted Scabies First published: January 1985 https://doi.org/10.1111/j.1365-4362.1985.tb05469.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume24, Issue1January 1985Pages 292-292 RelatedInformation

Norwegian Scabies (Crusted Scabies)

Norwegian Scabies (Crusted Scabies)