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.