Crusted Scabies in a Malnourished Patient: A Rare Case Report

Scabies is a parasitic skin condition, with crusted scabies (CS) being a severe and highly contagious variant characterized by thickened skin lesions and a high mite count. CS is typically associated with immunocompromised individuals but can also develop in those suffering from malnutrition, as malnutrition weakens immune responses and impairs skin integrity.

We report a case of CS in a 50-year-old malnourished male with no history of scabies or systemic disease, recently incarcerated. He presented with widespread itching, hyperkeratotic papules on the palms and soles, and secondary impetigo. The patient showed signs of malnutrition, with a BMI of 15.6 kg/m² and muscle wasting. Sarcoptes scabiei mites, eggs, and scybala were identified microscopically. The case was classified as Grade 3 CS. Treatment included two doses of ivermectin (8 mg) one week apart, 10% sulfur ointment, and benzyl benzoate soap. Follow-up was incomplete, highlighting challenges in managing socially vulnerable patients.

This case emphasizes the importance of early recognition, accurate diagnosis, and effective treatment of CS, especially in settings with poor sanitation and overcrowding. The patient's malnutrition likely contributed to the severity of the condition, as compromised immunity can facilitate mite proliferation.

A holistic approach addressing malnutrition, sanitation, and patient education is crucial in managing CS in resource-limited settings.