
Scrape to Nail the Diagnosis: A “Mitey” Challenge in an Erythroderma
WD01-WD02
Correspondence
Dr. S Praveen Kumar,
Associate Professor, Department of Dermatology, Ramaiah Medical College and Teaching Hospital, MSRIT Post, Bengaluru-560054, Karnataka, India.
E-mail : drpraveen.1982@gmail.com
Norwegian (crusted) scabies is a highly contagious form of scabies which can evolve into erythroderma at times. We herein report a case of a 29-year-old male patient, an established case of Epidermolysis Bullosa Dystrophica (EBD), presented to us with asymptomatic generalised scaling and crusting of two months duration. On examination patient also had dystrophic nails, anonychia and joint contractures. With a high index of suspicion, a scraping for KOH mount was done, which showed numerous scabies mites, eggs and faecal pellets. The patient was started on weekly oral Ivermectin (200 mcg/kg) and topical 5% permethrin application. There was dramatic response within 1-2 weeks. This case is presented to highlight the diagnostic challenge that erythroderma may be due to Norwegian scabies or the primary entity- EBD. The association of EBD and Norwegian scabies has been reported in literature. A simple bedside test like scraping can nail the diagnosis, provided there is a high index of suspicion.