Selamawit Worku Asmare
Department of Dermatovenereology, Addis Ababa university, School of Medicine, Addis Ababa, Ethiopia
Title: Erythroderma secondary to crusted scabies in immunecompromised patient
Biography
Biography: Selamawit Worku Asmare
Abstract
Scabies is Skin infestation caused by the penetration of the obligate human parasitic mite Sarcoptes scabiei var. hominis into the epidermis. Crusted scabies is rare and severely debilitating form of presentation. It accounts for <0.5% cases of erythroderma. The rarity of this presentation makes crusted scabies a diagnostic challenge.
A 34 years old male patient presented with Skin rash of 3 months duration. He is a known RVI patient for the past 5 years on HAART with CD4 count of 145. The rash initially started from finger web and progressively worsened to involve trunk, abdomen, extremities, and genitalia. It is associated with mild and occasional itching. On integumentary system there was Hyperkeratotic crusted plaque with fissuring over trunk, abdomen, and bilateral upper and lower extremity with significant underlying erythema involving > 90% BSA. There was involvement of palm and sole. He was being treated for Atopic Dermatitis with topical steroid at different clinics. Investigated with Complete blood count, renal function test, liver function test, serum electrolytes, albumin and all within normal range. Skin scrapping examined under microscope revealed scabies mite. With this he was diagnosed with Erythroderma secondary to crusted scabies. He was treated with oral ivermectin 200mcg/kg/dose given on day 1,2,8,9 and 15 and 25% benzoyl benzoate applied daily for 7 days, then twice weekly for 5 weeks and keratolytic. He had significant improvement after 5 weeks of treatment.
This case indicates that crusted scabies is associated with HIV infection and that it can result in erythroderma. And since typical symptoms of scabies are usually absent, high index of suspicion is necessary to reach to diagnosis.