Scabies presenting as cutaneous nodules or malar erythema: reports of patients with scabies surrepticius masquerading as prurigo nodularis or systemic lupus erythematosus

Werbel, Tyler; Hinds, Brian; Cohen, Philip R.

doi:10.5070/d3249041414

Cited by 13 publications

(6 citation statements)

References 19 publications

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“…Regrettably, only a few research studies have concentrated on the impact of ivermectin on T-cell-mediated autoimmune illnesses, which include MS, rheumatoid arthritis, type 1 diabetes, inflammatory bowel diseases (IBD), Sjogren's syndrome, systemic lupus erythematosus, and psoriasis. While case reports have displayed the protective effect of ivermectin on systemic lupus erythematosus [41][42][43] and psoriasis [44], there is still insufficient evidence to demonstrate its effectiveness on rheumatoid arthritis, type 1 diabetes, and Sjogren's syndrome. Moreover, the few investigations carried out on IBD and MS have solely centered on animal models [17,45].…”

Section: Discussionmentioning

confidence: 99%

Ivermectin Protects Against Experimental Autoimmune Encephalomyelitis in Mice by Modulating the Th17/Treg Balance Involved in the IL-2/STAT5 Pathway

et al. 2023

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Multiple sclerosis (MS), a T-cell-mediated autoimmune disease that affects the central nervous system (CNS), is characterized by white matter demyelination, axon destruction, and oligodendrocyte degeneration. Ivermectin, an anti-parasitic drug, has anti-inflammatory, anti-tumor, and antiviral properties. However, to date, there are no in-depth studies on the effect of ivermectin on the function effector of T cells in murine experimental autoimmune encephalomyelitis (EAE), an animal model of MS. Here, we conducted in vitro experiments and found that ivermectin inhibited the proliferation of total T cells (CD3 + ) and their subsets (CD4 + and CD8 + T cells) as well as T cells secreting the pro-inflammatory cytokines IFN-γ and IL-17A; ivermectin also increased IL-2 production and IL-2Rα (CD25) expression, which was accompanied by an increase in the frequency of CD4 + CD25 + Foxp3 + regulatory T cells (Treg). Importantly, ivermectin administration reduced the clinical symptoms of EAE mice by preventing the infiltration of inflammatory cells into the CNS. Additional mechanisms showed that ivermectin promoted Treg cells while inhibiting pro-inflammatory Th1 and Th17 cells and their IFN-γ and IL-17 secretion; ivermectin also upregulated IL-2 production from MOG 35-55 -stimulated peripheral lymphocytes. Finally, ivermectin decreased IFN-γ and IL-17A production and increased IL-2 level, CD25 expression, and STAT5 phosphorylation in the CNS. These results reveal a previously unknown etiopathophysiological mechanism by which ivermectin attenuates the pathogenesis of EAE, indicating that it may be a promising option for T-cell-mediated autoimmune diseases such as MS.

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Section: Discussionmentioning

confidence: 99%

Ivermectin Protects Against Experimental Autoimmune Encephalomyelitis in Mice by Modulating the Th17/Treg Balance Involved in the IL-2/STAT5 Pathway

et al. 2023

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“…The authors found a positive ANA of 1:320 with skin preparation significant for scabies mite infection [ 10 ]. Similarly, in a case presented by Werbel et al, a middle-aged African American female with immune thrombocytopenic purpura (ITP), malar erythema, and a desquamative skin rash on the chest and arms was diagnosed with a scabies infection [ 11 ]. A skin sample preparation was not obtained in our patient during her initial emergency room visit but, the diagnosis of scabies is mainly made based on the patient’s clinical presentation [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Scabies treatment is usually with a permethrin 5% cream or lotion for seven to 10 days which kills both the mites and eggs [ 9 ]. Both scabies and autoimmune conditions such as SLE cause a rash, therefore, it is important to differentiate between them especially since there have been reported cases of scabies mimicking the presentation of autoimmune cutaneous disorders [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Systemic Lupus Erythematosus vs. Mixed Connective Tissue Disease Disguised As Scabies

Liang¹,

Landry²,

Saliaj³

2022

Cureus

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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves numerous body systems and may initially present as a malar or discoid rash. When there are features of other autoimmune disorders present, such as scleroderma or polymyositis, the term mixed connective tissue disorder (MCTD) may be used. The current literature illustrates that the diagnostic criteria for MCTD are unclear. Additionally, the literature presents cases of scabies mimicking the presentation of various autoimmune disorders with cutaneous manifestations. We introduce a case of a young African American female who developed a pruritic rash on her face, abdomen, hands, and scalp. An initial diagnosis of scabies was made, however, failed to improve after a course of permethrin 5% topical cream. Subsequently, she was hospitalized, and diagnosed with pancytopenia, cardiomyopathy, microscopic hematuria and trace proteinuria. Systemic lupus erythematosus/scleroderma overlap syndrome was later confirmed by serologic testing. The patient was started on corticosteroids, with resultant improvement in her symptoms and laboratory findings.

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“…Therefore, in 2017, the term scabies surrepticius was proposed to cover all atypical manifestations of scabies. Scabies surrepticius includes crusted scabies, hidden, incognito, bullous, nodular, and other less common morphologies that may mimic dermatitis, ecchymoses, Langerhans cell histiocytosis, dermatitis herpetiformis, systemic lupus erythematosus, urticaria, urticaria pigmentosa, pityriasis rosea, and prurigo nodularis (18)(19)(20)(21). Scabies surrepticius is not characterized by the usual clinical symptoms, the lesions can mimic other skin diseases.…”

Section: Scabies Surrepticus Presenting As Chronic Urticaria -A Case ...mentioning

confidence: 99%

“…The clinical presentation of the disease may resemble infections caused by other sources such as parasites, viruses, bacteria, and fungi (3). It is also very commonly misdiagnosed as eczema, dermatitis, lupus erythematosus and prurigo nodularis (22). Often, this form occurs in patients with scabies who are treated with corticosteroids, which leads to an improvement in clinical symptoms, a reduction in the patients' skin complaints, but the mites remain and the patients continue to be infectious.…”

Section: Scabies Surrepticus Presenting As Chronic Urticaria -A Case ...mentioning

confidence: 99%

Scabies Surrepticus Presenting As Chronic Urticaria – A Case Report And Literally Review Of Diagnosis Method And Treatment

Velevska,

Georgieva,

Stoyanova

2023

IJHMR

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Scabies surrepticius represents the non-classic atypical presentation of scabies and diagnosing scabies in these individuals could be difficult. We present a clinical case of a 71-year-old woman with intense body pruritus for about 2 years, unresponsive to oral and topical antibiotics, corticosteroid creams, topical calcineurin inhibitors, as well as antiallergic agents, due to a suspected allergic reaction.

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Scabies presenting as cutaneous nodules or malar erythema: reports of patients with scabies surrepticius masquerading as prurigo nodularis or systemic lupus erythematosus

Cited by 13 publications

References 19 publications

Ivermectin Protects Against Experimental Autoimmune Encephalomyelitis in Mice by Modulating the Th17/Treg Balance Involved in the IL-2/STAT5 Pathway

Ivermectin Protects Against Experimental Autoimmune Encephalomyelitis in Mice by Modulating the Th17/Treg Balance Involved in the IL-2/STAT5 Pathway

Systemic Lupus Erythematosus vs. Mixed Connective Tissue Disease Disguised As Scabies

Scabies Surrepticus Presenting As Chronic Urticaria – A Case Report And Literally Review Of Diagnosis Method And Treatment

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