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LETTER TO EDITOR
Year : 1994  |  Volume : 60  |  Issue : 3  |  Page : 180-181

Out break of scabies from a case of Norwegian Scabies




Correspondence Address:
R R Mittal


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How to cite this article:
Mittal R R, Jot T, Chopra A K. Out break of scabies from a case of Norwegian Scabies. Indian J Dermatol Venereol Leprol 1994;60:180-1

How to cite this URL:
Mittal R R, Jot T, Chopra A K. Out break of scabies from a case of Norwegian Scabies. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2019 Oct 19];60:180-1. Available from: http://www.ijdvl.com/text.asp?1994/60/3/180/4038


To the Editor,

Patients of Norwegian scabies (NS) have high mite population and present with hyperkeratotic crusted papules. [1] NS occurs more in patients of autoimmune disorders due to associated immunosuppression. [2] Although scabies occurs in pandemics, localized epidemics in chronic health care facilities are known. [3] One such localized epidemic was treated with 5% permethrin and other with 1% Lindane. [4],[5]

A 36-years-female was admitted as a case of systemic lupus erythematosis (SLE), erythroderma and NS. She had SLE since 6 years which was controlled with 20-40 mg prednisolone daily. 6 months prior to admission she and her family developed scabies which was treated in all except the patient where it progressed to infected crusted papules, nodules, pustules, ulcers & erythroderma i.e. NS. Lesions were more in webspaces, around nipples and groins etc. SLE also worsened as she developed photosensitivity, dyspnoea on exertion, severe anaemia, oedema feet, loss of weight and appetite. She had intense pruritus with nocturnal itching and insomnia. Diffuse hair loss, residual lupus hair with scaling and crusting of scalp were seen. Generalised lymphadenopathy was present. Liver was enlarged by 3 fingers, smooth, soft and slightly tender. 2 bed sores, of 3 cm and 4.5 cm in diameter with yellow granulation were seen on buttocks. She was restless and at times aggressive since 15 days.

NB was 4.0 gm %. TLC was 10,700. DLC was P 71 , L 22 , E 5 , M 2 . ESR was 30 mm. TSP were 5.5 gm %, albumin 2.6 gm % and globulins 2.9 gm %. Urine sugar was 0.5%. FBS was 60 mg %. Scrapings revealed Sarcoptes scabei.

Strangely, within 10-30 days of her admission, all junior residents, patient's attendents, other female ward patients, nursing staff and later their families developed common type of scabies. Patient was treated with 10% crotamiton till ulcers healed and erythroderma was controlled. Repeated applications of 1% lindane cured NS in 3 months. All her clothes and bed linen were boiled daily. All others suffering in this localized epidemic were treated with 1% lindane.

SLE patients lack proper immunity and added immunosuppression was evident in this patient as she was receiving systemic steroids since 6 years. She developed scabies which became progressive despite treatment and turned into NS with high mite population and high degree of contagiousness. This was a unique challenging experience.

 
  References Top

1.Hubler WR, Clabaugh W. Epidemic Norwegian scabies. Arch Dermatol 1976; 112: 179-81.  Back to cited text no. 1    
2.Burns DA. Diseases caused by Arthropods and other Naxious Animals. In: Textbook of Dermatology (Champion RH, Burton JL, Ebling FJG, eds) 5th edn. Oxford : Blackwell Scientific Publications, 1992; 1305-7.  Back to cited text no. 2    
3.Burns D A. An outbreak of scabies in a residential house. Br J Dermatol 1987; 117 : 359-61.  Back to cited text no. 3    
4.Yonkosky D, Ladia L, Gackenheimer L, et al. Scabies in a nursing home: an eradication programme with permethrin 5% cream. J Am Acad Dermatol 1990; 23 : 1133-6.  Back to cited text no. 4  [PUBMED]  
5.Holeness DL, Dekoven JG, Nethercott JR. Scabies in chronic Health Care Institutions. Arch Dermatol 1992; 128: 1257-60.  Back to cited text no. 5    




 

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