CRUSTED SCABIES: AN UNUSUAL CLINICAL MANIFESTATION

The patient, a 40‐year‐old Brazilian woman, was admitted to the Pernambuco Federal University Hospital with a dry extensive crusted eruption on her skin. She had a history of uterine carcinoma that had been treated by radiotherapy 3 years before. She had been losing weight for the past few years. The patient's husband had ordinary scabies, and the family history revealed other affected members. Her bed linen was always covered with scales. Physical examination revealed generalized cutaneous erythema and scaling. The palms were markedly hyperkera‐totic (Figs. 1 and 2). This caused discomfort under pressure. There was a mild pruritus and her nails were abnormal. No burrows or vesicles were seen. Laboratory studies revealed the following: anemia and eosinophilia of 12%. Immunoglobulins were normal. Her cel‐lular immunity was diminished. Sensitivity to dinitrochloro‐benzene and reactivity to intradermal injection of tuberculin, trichophytin, and candidin were negative. Direct light mi‐croscopy of thick scales showed a large number of Sarcoptes mites and numerous eggs. Microscopic examination of a biopsy specimen showed hyperkeratosis, acanthosis, and a chronic inflammatory infiltrate composed predominantly of lymphoid cells. The horny layer was riddled with innumer‐able mites. The patient was treated with a 20% urea ointment and 1% lindane lotion. The skin condition was significantly im‐proved after a 5‐day treatment with keratolytic ointment (2 times a day) and antiscabic lotion applied at night to the whole skin for a period of 5 days. Throughout the hospital stay she remained in good health and was discharged 10 days after admission with her dermatologic problem com‐pletely cured (Fig. 3). Four months later the patient died due to a cerebral metastatic carcinoma.