An 85-year-old woman presented to our department from a nursing home with a 3-month history of generalized erythema and scaling, associated with moderate pruritus. A prior diagnosis of psoriasis was made. Clinical examination showed extensive erythema and heaps of greyish-yellow scales especially on the face, scalp, hands and trunk (Figure 1). The rest of the skin appeared diffusely xerotic. Scraping from scales revealed the presence of numerous mites and eggs, compatible with a diagnosis of Norwegian Scabies (NS). After removal of crusts from the skin surface, we treated our patient with repeated application of permethrin 5% cream, until complete healing.
Extensive erythema and heaps of greyish-yellow scales on the face.
NS is a severe form of scabies infestation, which usually occurs in people who are immunosuppressed, severely physically incapacitated or the elderly. Unlike classical scabies, it is characterized by a plethora of mites on the skin surface and also affects the scalp, face, back and the periungual folds. Moreover, pruritus is usually absent or moderate. NS is often misdiagnosed as psoriasis, hyperkeratotic eczema, contact dermatitis or Darier’s disease.1,2 As NS is highly contagious, it is often the cause of community epidemics. Given the large number of mites in the epidermis and the hyperkeratotic skin, the NS can be very difficult to treat and often repeated cycles of topical scabicidal agents are required.