大疱性疥疮

报告1例大疱性疥疮。患者男,65岁。3个月前无明显诱因躯干、四肢出现散在红斑、水疱、糜烂、结痂,伴瘙痒。患者1个月前指缝间、阴囊处出现类似红斑、丘疹,瘙痒明显。皮肤科检查:躯干、四肢可见弥漫性红斑,部分红斑上可见紧张性水疱,疱壁紧张,疱液清亮,部分水疱破裂后糜烂,可见红色糜烂面,部分表面结痂;双手指缝间、阴囊散在红斑,苔藓样变,可见抓痕。皮损组织病理检查:(左股内侧皮损)角化不全,浆液渗出,可见表皮下疱,疱内可见浆液,大量嗜酸性粒细胞及红细胞,真皮浅层可见嗜酸性粒细胞及中性粒细胞浸润;直接免疫荧光:皮肤全层未见特异性荧光,间接免疫荧光:真皮与表皮交界处(-);镜检发现疥螨。诊断:大疱性疥疮。     

Oral ivermectin treatment in two cases of scabies: effective in crusted scabies induced by corticosteroid but ineffective in nail scabies

We report two cases of scabies treated with oral ivermectin (200 micro g/kg). Case 1, a 72-year-old man, developed crusted scabies with the use of oral corticosteroids due to a misdiagnosis by an earlier physician. The patient was successfully treated with two doses of oral ivermectin at a 7 day interval with concomitant topical use of crotamiton and keratolytic agents. However, the nail scabies in this patient failed to respond to these treatments. Live mites were detected from all his toenails two weeks after the second dose of ivermectin. A complete cure of the nail scabies was achieved by occlusive dressing of 1% gamma-BHC on all toenails for one month. Case 2, a 52-year-old woman, had been treated with oral corticosteroid for mesangial nephritis. She developed common scabies, but a topical scabicide, crotamiton, was not effective. Two weeks after treatment with a single dose of oral ivermectin, eggs were still detected from a burrow on her trunk. Her treatment was completed after a further two doses of oral ivermectin were administered at 7 day intervals. In both patients, the administration of oral ivermectin did not induce any clinical or laboratory side effects. Oral ivermectin is effective for crusted scabies, but not effective for nail scabies. Two doses of oral ivermectin, administered with a one-week interval, is an appropriate treatment regimen.     

Oral ivermectin in scabies patients: a comparison with 1% topical lindane lotion

Scabies. which constitutes a significant proportion of the outpatient attendance in tropical dermatology clinics, has so far been treated with lindane, crotamiton, sulphur, permethrin, etc. Ivermectin, an orally administered drug, was tried in scabies patients and compared with 1% topical lindane lotion to evaluate its effects and toxicity profile. Two hundred scabies patients were randomly allocated to one of two groups. One group received oral invermectin in a single dose of 200 micrograms/kg body weight. The other received 1% lindane lotion for topical application overnight. Patients were assessed after 48 hours, two weeks and four weeks. After a period of four weeks, 82.6% of the patients in the ivermectin group showed marked improvement; only 44.44% of the patients in the lindance group showed a similar response. A side effects in the form of severe headache were noted in one patient in group A. Oral ivermectin is an easy drug to administer. It is given as a single oral dose, unlike lindane, which has to be applied topically. The compliance is accordingly increased. Moreover, ivermectin induces an early and effective improvement in signs and symptoms. Thus, it may be a better option for scabies than the traditional topical linlane lotion.     

Variable response of crusted scabies to oral ivermectin: report on eight Egyptian patients

Background  Several reports have proved the efficacy of oral ivermectin in the treatment of crusted scabies. However, the response varied greatly between different studies.
Objective  The aim of this study was to evaluate the response of crusted scabies to oral ivermectin in eight Egyptian patients.
Patients and Methods  Eight patients with crusted scabies, diagnosed clinically and confirmed microscopically, were involved in this study. Patients received a single oral dose of ivermectin (200ug/kg) and re-examined at 2, 4, 6 and 8 weeks. A second dose of ivermectin was given in case of treatment failure at the end of the second week. A third dose of ivermectin, combined with permethrin 5% and salicylic acid 5% was given at the end of the fourth week for the nonresponders to the second dose.
Results  Two patients were completely cured after a single dose of ivermectin, 4 patients required a second dose at a 2-week interval to achieve cure and 2 patients cleared from scabies after the combined therapy. No recurrence was reported at the end of 8 weeks. An inverse relation was observed between the response to ivermectin and the severity of immunosuppression, crust thickness and mite burden.
Conclusion  Oral ivermectin is an effective alternative therapy for the treatment of crusted scabies. The response of crusted scabies to oral ivermectin is variable and combination therapy with topical scabicides and keratolytics seems to be the best choice.     

Scabies associated with a bullous pemphigoid-like eruption

We report a patient who developed a bullous-pemphigoid-like eruption associated with scabies. A subsequent recrudescence of the scabies was associated with recurrence of the bullous eruption.     

Effect of clarithromycin in a case of infantile bullous pemphigoid

Although rare, cases of infantile or childhood bullous pemphigoid are increasingly being reported in the literature. Treatment challenges, which are amplified in infancy, necessitate balancing efficacy and avoiding long-term risks. In this report, clarithromycin was successfully used to establish and maintain disease remission, offering insights into its immunomodulatory effects, making it a compelling steroid-sparing choice with a favorable side effect profile.     

Crusted (Norwegian) scabies in a patient with dystrophic epidermolysis bullosa

A 13-year-old girl with severe non-mutilating recessive dystrophic epidermolysis bullosa (EB) was admitted to hospital because of a Staphyloccus aureussepsos, deterioration of her general condition and worsening of her skin disease, which itched severely. In addition to the blisters and erosions normally seen, she was covered from head to toe with scales and hyperkeratotic crusts. Despite intensive topical therapy, her skin condition did not improve significantly until scabies was detected and treated 1 week after admission. Because of the huge number of mites found and the crusted appearance, a diagnosis of crusted (Norwegian) scabies was made. She was successfully treated with two doses of ivermectin orally and one application of lindane ointment. Permethrin cream was not tolerated. In this patient crusted scabies may have developed because of: (i) a modified host response due to malnourishment; (ii) inability to scratch because of the absence of fingernails; and (iii) abnormal scratching behaviour because of the vulnerability of EB skin, or a combination of these factors. Limited isolation measures were taken on admission and full measures were taken immediately after the diagnosis of crusted scabies was made. Prophylactic treatment of ward personnel was not undertaken. Fortunately, there was not an outbreak of scabies in the hospital.     

The use of ivermectin in controlling an outbreak of scabies in a prison

BACKGROUND: Ivermectin is a potentially useful treatment for scabies. OBJECTIVES: We aimed to evaluate the efficacy of ivermectin in the treatment of scabies in an institutional environment. METHODS: A single dose of ivermectin 150 microg kg-1 was given under supervision to 1153 prisoners in a prison in northern Tanzania where there was an outbreak of scabies. RESULTS: Thirty per cent of the prisoners were cured after 1 week, 88% after 4 weeks and 95.5% after 8 weeks. Of 16 prisoners with crusted scabies, seven (44%) still had scabies after 8 weeks. Those who were not cured were then treated with 1% lindane lotion topically, as were the prison staff who had scabies. This regimen eradicated scabies from the prison for the next 2 years. CONCLUSIONS: Ivermectin is an effective and safe treatment for scabies, particularly in a closed community, such as a prison, where it is easy to administer and avoids problems with compliance. It was of limited efficiency in crusted scabies as a single dose and we recommend that for such patients oral ivermectin is used in combination with a topical scabicide.     

Clinical efficacy and safety of topical versus oral ivermectin in treatment of uncomplicated scabies

Many medications are available for scabies treatment including oral and topical ivermectin. However, studies comparing these two forms as a scabies treatment are few. This study compares efficacy and safety of topical versus oral ivermectin as scabies treatment. The study included 62 confirmed uncomplicated scabies patients, divided into: Group I (32 patients, received topical ivermectin) and Group II (30 patients, received oral ivermectin). Patients were assessed, clinically and by KOH smear at 1, 2 and 4 weeks. Treatment was repeated after one week in patients with persistent infection. Adverse events were recorded. Most patients (87.5% and 73.5% in group I and group II respectively) were symptom free after a single treatment. A second treatment was required in 4 patients of group I and 8 patients of group II. However, 2 weeks after treatment symptoms and signs completely resolved in all cases with no recurrence at 4 weeks. This study suggests that both topical and oral ivermectin are safe and equally effective in treatment of uncomplicated scabies. Single treatment, whether topical or oral, is associated with high cure rate in a week post treatment. However, repeating treatment after one week may be required to achieve 100% cure.     

挪威疥疮1例

报告挪威疥疮１例。患者男６５岁，头皮，颈肩、胸背、上肢、手背大片厚层痂子，不易刮落，阴囊部抓痕，散在结节。瘙痒不明显。痂皮外疥螨成虫、虫卵镜检（＋）。外用硫柳膏治愈。     

挪威疥误诊一例

患者女,72岁,因老年痴呆长期在某老年养护中心住院。因全身红斑、脱屑伴痒1年,加重伴掌跖及头皮角化厚痂3周,经常搔抓影响睡眠。初起皮疹时曾诊断为湿疹、真菌感染,予以抗组胺药及抗真菌治疗效果不佳,患者皮损进一步加重而请皮肤科会诊……     

表现为红皮病的挪威疥一例

患者,女,53岁。双上肢红斑、丘疹伴瘙痒1年,泛发全身3个月,曾误诊为"过敏",予抗组胺药、糖皮质激素软膏治疗,皮损未见明显好转。皮肤活检及显微镜镜检发现疥螨,给予氧化锌硫软膏外用。     

Guideline for the diagnosis and treatment of scabies in Japan (second edition)

The guideline has been prepared by the Japanese Dermatological Association to ensure proper diagnosis and treatment of scabies, as oral therapy became available on August 2006 under health insurance and its clinical use was expected to increase. For making a proper diagnosis, the following three points should be taken into consideration: (i) clinical symptoms; (ii) detection of the mite (Sarcoptes scabiei); and (iii) epidemiological symptoms. The diagnosis is confirmed if the mites or eggs are identified by microscopy or dermoscopy and so forth. Topical sulfur preparations, with only limited usefulness, are the only available topical drugs approved by health insurance coverage for treating scabies. Currently, crotamiton, benzyl benzoate and gamma-benzene hexachloride are also used clinically. It is important to apply these to the whole-body, including hands, fingers and genitals. The dose for ivermectin is a single administration p.o. of approximately 200 microg/kg bodyweight with water before a meal. Administration of a second dose is considered, if new specific lesions develop or the mites are detected. For treating crusted scabies, concomitant administration of oral ivermectin and the topical preparation is necessary. Some safe and useful topical drug preparations are needed to be approved by health insurance.     

Guideline for the diagnosis and treatment of scabies in Japan (third edition)

In the current work, we present our new guideline for the diagnosis and treatment of scabies which we, the Executive Committee convened by the Japanese Dermatological Association, developed to ensure proper diagnosis and treatment of scabies in Japan. Approval of phenothrin topical use under the National Health Insurance in August 2014 led to this action. Permethrin, a topical anti‐scabietic medication belonging to the same pyrethroid group as phenothrin, is already in use worldwide. In this guideline, we introduce criteria for a proper diagnosis of scabies, treatment algorithm for common and crusted (hyperkeratotic) scabies, and prevention. The major change from our second edition is the treatment algorithm. As phenothrin is now available, the first‐line therapy for common scabies is either topical phenothrin lotion or oral ivermectin. The second‐line option for topical treatment is sulfur‐containing ointments, crotamiton cream or benzyl benzoate lotion. γ‐Benzene hexachloride ointment is no longer provided for clinical use. In an immunosuppressed patient, the treatment option is still the same, but with close follow up. If the symptoms persist, diagnosis and treatment must be reassessed. For hyperkeratotic scabies and nail scabies, removal of thick crust, cutting of nails and occlusive dressing are additionally required. The safety and effectiveness of combined treatment with topical and oral medications are not yet confirmed. Further assessment is needed. In addition to appropriate treatment, it is essential to educate patients and health‐care workers and to conduct epidemiological studies to prevent further spread of the disease through effectively utilizing available resources including manpower, finance, logistics and time.     

大疱性硬斑病1例

报告1例少见的大疱性硬 斑病。患者男性,25岁。四肢皮肤明显硬化萎缩,部分关节强直固定。左前臂伸侧大小不等的水疱,尼氏征阴性。无雷诺现象等系统损害。病理检查为典型的真皮均一化胶原纤维变性等硬皮病表现及表皮下水疱。     

A unique case of subepidermal bullous disease

A 72-year-old Japanese woman developed small, asymptomatic, subepidermal vesicles on the limbs, back, chest and abdomen. Immunoperoxidase staining of the lesional skin showed linear deposition of IgG, IgA and C₃ along the basement membrane zone (BMZ), and indirect immunofluorescence studies revealed IgG and IgA class circulating anti-BMZ auto-antibodies in the patient's serum. Ultrastructurally, the vesicles were caused by dermo-epidermal separation at the lamina lucida, and the immune deposits were located just beneath the basal lamina in a band-like pattern. Immunoelectron microscopic observation of normal human skin incubated with the patient's serum using an organ culture system revealed that the anti-BMZ antibodies reacted with the anchoring fibrils. Administration of dapson was not effective, but betamethasone was. This case of subepidermal bullous disease is unique and cannot be classified into any existing category of bullous dermatoses.     

误诊为湿疹的挪威疥一例

患者,男,24岁。全身皮肤起丘疹伴瘙痒1年余就诊。当地医院曾按“泛发性湿疹”予抗过敏治疗,皮损未见好转。取皮疹鳞屑镜检见疥螨。诊断：挪威疥。经治疗痊愈。