By Gary M. White, MD
In crusted scabies, the patient is covered with thousands of mites and the skin develops a hyperkeratotic surface.
By definition, the patient with scabies develops thicken, hyperkeratotic plaques. In severe cases, the skin may be dramatically encased with thick crusts (see reference below).
Rarely, crusted scabies may be fatal, as patients can die from sepsis. Typically, these patients are elderly, with poor hygiene and a compromised immune system, e.g. uncontrolled diabetes or HIV AIDS.
The repeated use of topical 5% permethrin combined with oral ivermectin 200 µg/kg is optimal. The CDC has recommended the following [Center for Disease Control. Workowski, Kimberly L. et al. STD Treatment Guidelines 2015. MMWR. June 5, 2015 64(RR3); 1-137]:
Topical Permethrin Cream 5%: Apply to entire body; leave on for 8 to 14 hours before washing off with water. Repeat this regimen daily for 7 days, and then twice weekly until symptoms have resolved.
Oral Overmectin should be given concomitantly on days 1, 2, 8, 9, and 15 (and potentially on days 22 and 29 for severe cases)
See also scabies.
A 33-year-old woman with thick encrusted plaques before and after treatment. An Bras Dermatol. 2012 Nov-Dec; 87(6): 910–913.
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