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    Abstract
    Introduction
    Case Report
    Discussion
    References

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CASE REPORT
Year : 2003  |  Volume : 69  |  Issue : 7  |  Page : 9-10

Scabies with bullous pemphigoid - like eruption


Department of Skin, V.D. & Leprosy, Government Medical College and Sir T Hospital, Bhavanagar, 364 001, Gujarat

Correspondence Address:
201, Golden arc apartment, Atabhai chowk, Bhavnagar, 364 002 Gujarat

   Abstract 

Association of scabies with a bullus pemphigoid - like eruption is being reported because of its rarity. Histopathology revealed subepidermal bullae with intact basal layer. Treatment with topical gammabenzene hexachloride and systemic antibiotics was effective.

How to cite this article:
Shah H, Mehta A, Shah K, trivedi A. Scabies with bullous pemphigoid - like eruption. Indian J Dermatol Venereol Leprol 2003;69, Suppl S1:9-10


How to cite this URL:
Shah H, Mehta A, Shah K, trivedi A. Scabies with bullous pemphigoid - like eruption. Indian J Dermatol Venereol Leprol [serial online] 2003 [cited 2019 Jun 24];69, Suppl S1:9-10. Available from: http://www.ijdvl.com/text.asp?2003/69/7/9/5836



   Introduction Top

The itch mite, Sarcoptes scabiei var humanus, discovered in 1687, makes scabies one of the first disease with a known cause.[1] The infestation with Sarcoptes scabiei often is masquerading as and mimicking different skin disease “the great imitator in dermatology”.[2] Vesicles are common in children with scabies but uncommon in adults. Some patients with scabies develop bullae concomitantly with, or subsequently after, the occurrence of scabetic lesions. Here we report a case of bullous scabies resembling bullous pemphigoid in a 10-year-old boy.


   Case Report Top

A 10-year-old boy studying and staying in Madresa presented with generalized, nocturnal itching and multiple blistering skin disease for 10 days. There was history of generalized itching in other inmates of madresa. Clinical examination revealed multiple vesiculobullous lesions on face, chest, abdomen, back, webs of fingers and genital region. Bullae were tense in nature and there was collection of pus at some places.
Routine hemogram examination was normal. Histopathological findings epidermis. The blister cavity contained inflammatory cells mainly polymorphs, eosinophils and few lymphocytes. Patient was treated with topical gamma benzene hexachloride and systemic and local antibiotics.


   Discussion Top

Most dermatologists are familiar with the diagnosis of scabies. Our patient was unusual because most of his lesions were vesiculobullous. In our patient, short duration of illness, nocturnal pruritus, similar complaints in other inmates, distribution of bullous lesions and histopathology showing subepidermal blister with intact epidermis forming its roof encouraged us to label the patient as having bullous scabies. How the mite induces vesicles/bullae formation is not well understood. Viraben and Dupre suggested that blisters were related to type I hypersensitivity induced by scabies mites.[1] Most case reports have described negative/nonspecific findings with direct immunofluorescence.[3] Slawsky et al demonstrated intense homogenous band of IgG and C3 deposition in the basement membrane zone of bullous lesions.[3] Konishi et al show that two scabetic patients bullous eruptions had circulatory antibodies against BP180 and/or BP230 as determined by Western blotting analysis. This is the first report to demonstrate that at least some of the bullous eruptions occurring in scabetics are true bullous pemphigoid.[4] Because of lack of facility, immunofluorescence studies could not be carried out in our case. The physiopathologic mechanism of bullous lesions in scabies remains speculative and needs further evaluation. 

   References Top

1.Milton Orlein. Scabies and pediculosis, In: Fitzpatrick's Dermatology in General Medicicne, Edited by Irwin Freedberg, McGraw - Hill Publishing, International edition, 5th edition, 1999; 2677-2680.  Back to cited text no. 1    
2.Assen I, Mohamed M, Vesicular scabies, Int. J Dermatol 1994; 33:149-150.  Back to cited text no. 2    
3.Slawsky LD, Marron M, Tyler WB, et al. Association of scabies with a bullous pemphigoid-like eruption, J Am Acad Dermatol 1996 34; 878-879.  Back to cited text no. 3    
4.Konishi N, Suzuki K, Tokura Y, et al. Bullous eruption associated with scabies; evidence for scabetic induction of true bullous pemphigoid, Acta Derm venereol 2000; 80:281-283.  Back to cited text no. 4    

 

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