Norwegian scabies in a psoriatic mental patient
Verner, E.; Shteinfeld, M.; Zuckerman, F.
Harefuah 112(7): 328-331
1987
ISSN/ISBN: 0017-7768 PMID: 3623293 Document Number: 289294
A 50-year-old woman with paranoid psychosis had an exacerbation of a psoriatic eruption with the appearance of diffuse pruritic psoriatiform lesions. An unexpected finding was that of several mites of Sarcoptes scabiei in a biopsy taken randomly from a psoriatic plaque. Definite improvement followed treatment with topical corticosteroids, and later antiscabies treatment cleared the eruption. One year later she was hospitalized with exactly the same clinical picture. Scraping of a crust from a gluteal lesion revealed about 15 mites, a finding compatible only with Norwegian scabies. Topical treatment with benzyl benzoate and corticosteroid cream brought prompt improvement. The patient's husband was similarly infected with scabies but no contacts among the the hospital staff were found to be infected. This may be explained by the fact that this mental patient had been neglected and every treatment or contact was performed with plastic gloves. This recurrent picture of Norwegian scabies is extraordinary and the co-existence of psoriasis made the diagnosis difficult. We recommend microscopic examination of randomly taken scales from lesions in every psoriatic patient with mental disease and recent exacerbation of skin lesions, to rule out the possibility of Norwegian scabies.