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Crusted scabies in a patient with lepromatousleprosy INFECTIOUS DISEASES


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w w w . e l s e v i e r . c o m / l o c a t e / b j i d

The Brazilian Journal of


Clinical image

Crusted scabies in a patient with lepromatous leprosy

Alexandra Peres Paim Pedra e Cal


, Cassio Porto Ferreira


, José Augusto da Costa Nery




a r t i c l e i n f o


Received12April2016 Accepted18April2016 Availableonline13May2016

Crusted scabies (CS) is a very contagious rare skin infes- tation caused by Sarcoptes scabiei var hominis, an obligate humanparasite, transmittedbyskin-to-skincontact.1 Clin- ically, it can present with psoriasiform skin lesions in acral distribution with variable whitish scaling. It usually involves the subunguealarea with nail hyperkeratosisand dystrophy.2 A56-year-old man, alcoholic,presentedwith a seven-month history ofpruritus (withnocturnal exacerba- tion), weight loss and muscle weakness. The patient is a knowncaseoflepromatousleprosy(LL),diagnosed22years agowithirregulartreatment,neurologicaldamageanddefor- mities.Onexamination,hyperkeratosiswithcrustedlesions on hands and feet with severe nail dystrophy. We also noted anerythematous scaling eruption in the face, neck, scalp, trunk,and arms(Fig. 1). Laboratory resultsincluded



a negative HIV and HTLV-1 tests, skin scraping revealed the miteandskinsmearshowed abacteriologicalindexof 6+.Thepatientstartedmultidrugtherapyformultibacillary leprosyandoralantihistamines,keratolytics,topicalperme- thrin (5%), and repeateddoses ofivermectin(200␮g/kg)on the 1st, 2nd, 8th, 9th, and 15th day. CS is a highly con- tagious rare variant of scabies and is frequently found in immunocompromisedpatients,mentallyretarded,orphysi- callyincapacitatedindividuals.3Infestedindividualsandtheir close contactsshouldbe treatedatthe same time, evenif asymptomatic.1 There are few reported casesshowing the associationbetweenCSandLL.InBrazil,duetothehighnum- berofleprosy,physiciansshouldbeawareofthepossibilityof CSinleprosypatientswhodevelopwidespreadhyperkeratotic eruptions.






braz j infect dis.2016;20(4):399–400

Fig.1–Clinicalmanifestationsofcrustedscabiesinfection(A)–(C)Hyperkeratoticdermatosiswithanacraldistributionand naildystrophy;(D)disseminatedexcoriations,crustsandscalingintheback;(E)and(F)leoninefacies,pruritusandscaling, alsocrustsintheear;(G)microscopicsectionofS.scabieimiteshowingsixlegsandthebiteapparatus.

Authors’ contributions

AlexandraPeresPaimPedraeCal,CassioPortoFerreiraand JoséAugustodaCostaNerycontributedtoclinicalcareand paperpreparation.

Conflicts of interest




2.HenggeUR,CurrieBJ,JägerG,LupiO,SchwartzRA.Scabies:a ubiquitousneglectedskindisease.Lancet.2006;6:769–79.

3.BarbosaAAJ,SilvaTM,SantosMI,etal.Coexistenceofan unusualformofscabiesandlepromatousleprosy.Acase report.PatholResPract.1996;192:88–90.


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