The patient was an 82-year-old woman with a history of hypertension, insulin-dependent diabetes mellitus and polymyalgia rheumatica, being treated with oral corticosteroids. She was referred to the dermatology department with a 9-month history of generalized pruritus, accompanied by hyperkeratotic plaques and numerous lesions in the form of linear burrows, predominantly on her scalp and breasts and in the interdigital spaces of both hands.1 She had applied topical corticosteroids, which had had a negative effect on her clinical status.2 It was also interesting to know that individuals with whom she lived were also affected (Figs. 1 and 2).

Figs. 1 and 2.

(1) Hyperkeratotic plaques and numerous linear burrow tracks distributed on the patient's trunk, predominantly in the facial area and on her breasts. (2) Hyperkeratotic plaques and linear burrows on the back of the hands, predominantly in the interdigital spaces.

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The suspected diagnosis was reached on the basis of the clinical signs and the results of dermatoscopic examination. The microscopic study of skin scales disclosed the presence of mites and their feces and eggs, and the diagnosis was confirmed. It important to include diseases such as ichthyosis and psoriasis in the differential diagnosis (Figs. 3–5).

Fig. 3.

Dermatoscopic image showing brownish structures, in the form of a “hang glider” at the end of the burrows (arrows).

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Figs. 4 and 5.

(4) Image from the histological study under direct vision (at 400×) showing a mite (arrows) and feces. (5) Histological study under direct vision (at 400×) showing eggs (arrows) and feces.

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Treatment is based on oral ivermectin, 5% salicylate vaseline in hyperkeratotic lesions and, in certain lesions, surgical debridement to facilitate the penetration of the topical treatment.

As a result of her comorbidities, the patient died of a respiratory tract infection before treatment for scabies could be initiated.

When a patient receiving immunosuppressive therapy has generalized pruritus—predominantly at night—with crusted lesions,3 and the individuals with whom the patient lives are affected, it is essential to perform a differential diagnosis that includes Norwegian scabies, which occurs relatively frequently in these individuals. Moreover, the incidence is rising as a consequence of the increasingly widespread use of immunosuppressive agents.

The authors declare they have no conflicts of interest.