An epidemic of scabies with unusual features and treatment resistance in a nursing home

An epidemic of scabies affecting elderly patients on one ward of a nursing home is described. The outbreak was characterized by a high degree of contagion and treatment resistance among patients suffering from malignant diseases and receiving immunosuppressive therapy. The clinical picture was unusual, with papules surmounted by scabies burrows and a high percentage of persistent nodular lesions. The origin of the outbreak was probably a patient with an exfoliative psoriasis, treated with an aromatic retinoid and potent topical corticosteroids. In view of the high recurrence rate, follow-up may be advisable especially in elderly patients.