Norwegian scabies in a supposedly healthy teenager

Crusted scabies or Norwegian scabies is a rare and extreme manifestation of scabies that occurs mainly in immunosuppressed patients. It is characterized by intense inflammatory reaction and squamous, hyperkeratotic and little pruritic lesions with a tendency to generalization. This study presents the case of a 15-year-old mixed-blood male who comes to the specialized dermatology consultation for having eight-month-progress skin lesions, which became widespread, accompanied by an estimated weight loss of ten kilograms. As relevant positive data the physical examination reveals disseminated erythematosus, papular and squamous skin lesions, with some excoriations due to scratching. Skin biopsy is performed and the report reveals the presence of mites in the most superficial layers of the epidermis. Direct examination of the skin scraping performed on the lateral regions of the hands shows the presence of numerous adult mites and eggs. The diagnostic conclusion of crusted or Norwegian scabies is reached, indicating topical treatment with permethrin (5 %), with a marked improvement at the third day of treatment. The patient is currently being followed up and asymptomatic.