UNAIR NEWS – Scabies is a skin disease shown by clinical features in the form of itching on the skin accompanied by excoriation and crusting due to parasitic infestation of Sarcoptes scabiei var hominis on the epidermal layer. One type of scabies rarely found is crusted scabies, characterized by thickening and appearance of scales on the skin due to the presence of a number of ticks in the skin layer, nail thickening, and dystrophy, atypical, and highly infectious.
Crusted scabies is often associated with a variety of immunocompromised conditions such as human immunodeficiency syndrome (HIV) infection, haematological malignancies, neurological diseases, and connective tissue diseases including systemic lupus erythematosus (LES). Therefore, Dwi Murtiastutik Dr., Sp.KK (K), FINSDV with her colleagues reported a case related to this disease to discuss the clinical aspects and its treatment in LES patients.
“The incident occurred in August 2017, a 28-year-old man was referred to the hospital with complaints of thick scabs on almost the entire body for 2 months. Complaints are accompanied by a rash and a little itching. The patient complaint of itching was getting worse at night and from sweating. The rash then spreads to almost the entire body and becomes thickened accompanied by painless scab, “explained the lecturer in the Faculty of Medicine (FK).
The patient, she added, then got a physical examination of the generalized region, especially the abdomen, upper arms and hands. Hyperpigmented macules with unclear borders covered by crusting, erosion, and some erythematous papules were found around the area. Whereas on laboratory examination, there was a decrease in hemoglobin, leukopenia, thrombocytopenia, and hypoalbuminemia, the patient was later diagnosed with systemic lupus erythematosus.
“Our patient was examined from skin scrapings in the lesion area and found Sarcoptes scabiei parasites in the form of nymphs, adult fleas, eggs, and scibala (parasitic droppings). The results of this examination indicated the patient may have a large number of lice under the skin and scab. The examination is a standard procedure for diagnosing scabies in patients, ” she said.
Patients were given therapy with permethrin 5% cream given twice a week throughout the body and combined with sulfur precipitate and salicylic acid (2-4 ointments) twice daily in the lesion area. Patient therapy is optimized by administration of chlorpheniramine maleate tablets and therapy for LES. There were clinical improvements after two week therapy.
“This case report emphasized the clinical picture of crusted scabies in LES patients. With the establishment of the right diagnosis, clinicians are expected to provide good and appropriate therapy to patients, ” she concluded.
Author: Dian Putri Apriliani
Editor: Nuri Hermawan