Case Presentation
A 15-year-old boy presented with a history of flaccid blister eruption on all four limbs and genital area for 2 months. It was preceded by intense pruritis leading to the appearance of fluid filled vesicles and pustules (Figure 1). They ruptured within a day, leading to skin erosions with crusting in some areas (Figures 2,3). There was no family history of autoimmune disorders.
The patient was admitted with differential diagnoses of Linear IgA disease and Chronic bullous disease of childhood (CBDC). His blood tests revealed raised Total Leukocyte Count and he was started on culture based oral antibiotics. Inconclusive skin biopsy report, unsatisfactory response to steroids in past and clues from family history regarding presence of pruritic, papular lesions in 2 siblings pointed towards infected scabies as a probable diagnosis. Initiating oral Ivermectin resulted in a drastic improvement in the lesions and intensity of pruritis over the next couple of days. He was discharged with rigorous counselling of patient and family regarding the correct application of topical scabicide (Permethrin 5% applied on day 1 and 7) and follow-up after 2 weeks revealed that the lesions and the symptoms had resolved completely.
Scabies classically presents with pruritus and skin lesions (papules, nodules, burrows) in the interdigital spaces of hands, trunk and genitals [1]. Atypical skin lesions like vesicles, pustules and bullae or superimposed infection of skin may result in misdiagnosis and inappropriate patient management [2]. In such cases, detailed history of the patient and acquaintances should be sought.