Photo Rounds Friday Archive

Itching and crusting of hands

Post Date: 12/18/2009

FIGURE 1	FIGURE 2
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A 2-year-old boy was brought in for treatment of severe itching and crusting of his hands. He also had a pruritic papular rash over the rest of his body. He’d had this problem since he was 2 months old and had received topical treatments that provided only temporary relief. Other adults and children in the house were beginning to itch and get a rash, as well.

What's your diagnosis?

This child had crusted scabies. The physician confirmed the diagnosis by performing a scraping. While the adult mite was not found under the microscope, the feces (scybala) were seen (FIGURE 2).

Human scabies is caused by the mite Sarcoptes scabei, an obligate human parasite. Adult mites spend their entire life cycle—around 30 days—within the epidermis. After copulation, the male mite dies and the female mite burrows through the superficial layers of the skin, laying eggs and feces. The previous attempts at treatment for this child had only been with topical permethrin.

The child and the rest of his family were put on ivermectin (0.2 mg/kg) simultaneously and the crusted scabies cleared from the child. Environmental decontamination included washing the clothing, bed linens, and towels in hot water. The scabies cleared from the family, as well, and the child was given a repeat dose of ivermectin in 1 week to avoid relapse.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chanoine P, Usatine R. Scabies. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:575-580.

To learn more about The Color Atlas of Family Medicine, see:
* http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
* http://www.mhprofessional.com/product.php?isbn=0071474641