Nodular scabies: a classical case report in an adolescent boy

Area of Science:

• Dermatology
• Parasitology

Background:

• Scabies is a contagious skin infestation caused by the mite Sarcoptes scabiei.
• Nodular scabies is a less common presentation, often characterized by persistent, itchy nodules, particularly in endemic areas or immunocompromised individuals.
• Classical scabies presents with pruritus and characteristic lesions, but nodular forms pose diagnostic and therapeutic challenges.

Purpose of the Study:

• To present a classical case of nodular scabies in a pediatric patient.
• To evaluate the efficacy of various treatment modalities for persistent nodular scabies.
• To highlight the management of recalcitrant nodular lesions in scabies.

Main Methods:

• A 12-year-old boy presented with a 3-week history of intense itching and skin lesions.
• Clinical diagnosis of scabies with nodular scabies was confirmed by microscopic examination of skin scrapings.
• Treatment involved topical permethrin, followed by topical steroids and tacrolimus, and ultimately intralesional triamcinolone injections for persistent nodules.

Main Results:

• Initial treatment with topical permethrin provided partial relief from itching and improved impetigo in a family member.
• Persistent nodular lesions on the scrotum and groin showed limited response to topical steroids and tacrolimus.
• Intralesional triamcinolone injections resulted in significant reduction in itching (30-40%) and lesion size (50-60%) over 2-3 weeks.

Conclusions:

• Nodular scabies can present as a diagnostic challenge, requiring thorough dermatological examination and microscopic confirmation.
• While topical treatments are standard for scabies, persistent nodular lesions may require alternative therapeutic approaches.
• Intralesional corticosteroid injections can be an effective option for managing refractory nodular scabies, offering symptomatic relief and lesion reduction.