
==== Front
Rev Soc Bras Med Trop
Rev Soc Bras Med Trop
rsbmt
Revista da Sociedade Brasileira de Medicina Tropical
0037-8682
1678-9849
Sociedade Brasileira de Medicina Tropical - SBMT

39230165
00924
10.1590/0037-8682-0199-2024
Images in Infectious Diseases
Crusted Scabies
https://orcid.org/0000-0002-1819-5630
Fernandes Nurimar Conceição 1 Conception and design data analysis manuscript writing final approval of manuscript
https://orcid.org/0000-0002-3968-6156
Silva Carolina Piccinini 2 Collection and assembly of data provision of patients
https://orcid.org/0000-0001-9914-2428
Tavares Gabriel Castro 2 Collection and assembly of data provision of patients
1 Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Dermatologia, Rio de Janeiro, RJ, Brasil.
2 Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Dermatologia, Programa de Residência Médica em Dermatologia, Rio de Janeiro, RJ, Brasil.
✉ Nurimar Conceição Fernandes. e-mail: nurimarfernandes@terra.com.br
Conflict of Interest: The authors declare that there is no conflict of interest.

02 9 2024
2024
57 e00924-202411 6 2024
05 7 2024
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License
==== Body
pmcA 25-year-old female from Rio de Janeiro presented with thick, gray, crusty keratotic scales on the skin throughout the body and mild itching at night (Figures 1 and 2). This immunocompromised, malnourished patient had manifested the disease for 1 month. Family members denied having similar signs and symptoms. She was hospitalized with single-room isolation and contact precautions. Microscopic examination with potassium hydroxide revealed mites and eggs of Sarcoptes scabiei var. hominis (Figure 3). Ivermectin (200 µg/kg) was prescribed once a week for 4 weeks, besides topical mineral oil twice daily. The patient died from skin secondary infection, sepsis, and advanced autoimmune disease. Crusted scabies (CS) is a rare clinical manifestation of scabies characterized by large crusted lesions and generalized thick grayish hyperkeratosis containing millions of highly contagious mites 1 , 2 . Although scabies are estimated to affect millions of people, no CS prevalence data exist globally or in Brazil. It spreads continuously through direct skin-to-skin contact with carriers or indirect contact with bedding and clothing. CS has been linked to a high mortality rate 1 . The most common cause of death is staphylococcal bacteremia. Ivermectin is a safe non-ovicidal drug, and in CS, it is given weekly depending on the severity and therapeutic response. Side effects include headache, nausea, dizziness, and gastrointestinal upset. Many side effects are thought to result from mite deaths rather than from the drug itself 3 . CS should be differentiated from psoriasis, seborrheic dermatitis, atopic dermatitis, and erythroderma. The grayish color of skin lesions is highly suggestive.

FIGURE 1: Patient showing diffuse grayish keratotic scales.

FIGURE 2: Grayish keratotic plaques on the abdomen with skin striae.

FIGURE 3: Potassium hydroxide scraping showing Sarcoptes scabiei mites.

Financial Support: The authors declare that is no financial support.
==== Refs
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