Norwegian Scabies management after prolonged disease course: A case report

Abstract

Introduction Scabies is a well – known, commonly recognized, and frequently diagnosed pathology especially in children, close quarters, living facilities, and immunocompromised patients. An accelerated severe infestation of traditional scabies with limited treatment options is known as the rare entity of Norwegian or Crusted Scabies. Case presentation We present the history, clinical manifestations, medical treatments and surgical interventions of a patient with Norwegian Scabies of his hands, which rendered them nonfunctional prior to intervention. The patient was initially misdiagnosed and underwent inappropriate treatments for several years prior to our assessment, and ultimately required surgical intervention that was therapeutic. Discussion Norwegian, or Crusted, Scabies is a severe infestation of S. scabiei in which the mite load is extreme in comparison to traditional scabies. This manifests as scaly plaques that are often misdiagnosed for other hyperkeratotic skin lesions. With this misdiagnosis, improper treatments are often recommended, and can even accelerate the manifestation. Traditional scabies therapies can be effective, however often due significant disease progression due to diagnostic delay, invasive measures, such as surgical debridement like presented here, are the only option. Conclusion The patient presented in this case harbored a rare infection, known as Norwegian Scabies, for several years, with inappropriate medical therapy. Due to his prolonged inadequate treatments, his disease became so pronounced that the recommended medical treatments were no longer adequate, thus he required surgical debridements which ultimately allowed him to regain function in his hands.

Erythrodermic Manifestation due to Hyperinfestation of Scabies

“…2,5,7 In this variant, scabies load can range from thousand to millions and exceedingly contagious. 8,9 In our case, the development of Norwegian scabies could be prevented by the correct diagnosis at the early-onset of the disease. However, due to various skin clinical presentations, the diagnosis of scabies is often missed, which leads to mistreatment of the infection.…”

Atkafélék okozta, bőrtünetekkel járó humán megbetegedések

“…Az atkák nagymértékben elszaporodnak, akár több millióan is jelen lehetnek a bőrön. Lappangási ideje 10-14 napra rövidül [3,10]. Kialakulásában hajlamosító tényezők az immunszuppresszív állapotok (például HIV-fertőzés, malignus hematológiai betegségek, kemoterápia), az időskor, a Down-szindróma, az önellátás képességének hiánya és a malnutritio [11].…”

“…Fő lokalizációi az arc, a fülkagylók, az interdigitalis vagy a genitalis területek, de megjelenhet a betegség konfluáló papulosus erupciók formájában is. A bőrtünetek másodlagos szuperinfekciója szeptikus állapothoz, az atípusos klinikai tünetek miatt a késleltetett diagnózis nosocomialis járványok kialakulásához vezethet [3,10,11]. Differenciáldiagnosztikai szempontból a crustosus scabies esetében elsősorban psoriasis, ichthyosis, lymphoproliferativ betegségek, generalizált ekzema, prurigo, kontaktdermatitis vagy Darier-betegség jön szóba [11].…”

Pelatihan Pencegahan Penularan Penyakit Scabies dan Peningkatan Hidup Bersih dan Sehat Bagi Santriwan

“…Penularan scabies biasanya karena kontak langsung atau tidak langsung. Keterlambatan dalam diagnosis dapat menyebabkan penyebaran kudis scabies (Aukerman, Curfman, Urias, & Shayesteh, 2019) (Melo, Ribas, & Encarnação, 2020). Pencegahan penyakit scabies, harus menggunakan manajemen yang tepat dari pengaturan panti jompo, pondok pesentren bahkan semua bentuk pendidikan boarding school termasuk pembersihan yang memadai dari pakaian, tempat tidur dan peralatan yang terkontaminas.…”