Crusts on the Scalp: It’s Scabies ! (Treatment Implications)

Take home message: Crusted Scabies is not Conventional Scabies: it can also affect the scalp ! Topical treatment of the scalp should be considered when scabies is diagnosed in infants, children and the elderly (Case Study from Taiwan)

Comments
-Crusted Scabies (Norwegian Scabies) is due to proliferation of a large number of mites due to the impossibility to scratch (neurological impairment) or in immunosuppressed individuals. Patients are often institutionalized or inpatients.
-It is very contagious (in conventional scabies, close contact is already sufficient). Do not miss the diagnosis: not giving proper management (isolation, treatment) could result in an outbreak !
-In another context, imagine seeing an old patient with crusting on the scalp…another diagnosis to think about !
–General information on Scabies: click HERE

Abstract
-Scabies is a common disease and typically described as a skin condition with sparing of face and scalp in adult. -Herein, we report an unusual case of crusted scabies with scalp infestation. A 91-year-old bed-ridden patient with diabetics mellitus, cerebrovascular accident and chronic obstructive pulmonary disease was admitted to ward of internal medicine department due to sepsis. Dermatologist was consulted for scaly scalp. Clinically, scaly plaque over occipital scalp was noted. On further examination, scaling lesions were also found over finger webs. There was no obvious skin lesion on other site of body. Skin scrapings from scalp lesion revealed many scabies mites, ova and scybala. Crusted scabies was diagnosed. Since oral ivermectin is not licensed in most countries. Currently, topical antiscabietics are the mainstay of treatment. Traditionally, topical scabicide do not involve the scalp because scalp involvement in scabies is believed very rare. Review the literature , We suggest that for cases with suspicious lesions on scalp, immunocompromised patients or relapse cases, crusted scabies, special age groups, such as infant, young children and the eldery, topical treatment of the scalp should be included.

Reference: Regional Congress of Dermatology (RCD) 2016 – Singapore. RCD16-0052 Cutaneous Infections ATYPICAL SCABIES PRESENTS AS SCALY SCALP Hsiu-Hui Chiu1, Chieh-Shan Wu2 1Pingtung Christian Hospital, dermatology, Pingtung County, Taiwan 2Department of Dermatology, Kaohsiung Veterans General Hospital