This photo is from an elderly man with advanced Alzheimer’s disease who currently lives in an old age home, is bed-bound and requires tube feeding via a Ryle’s tube. He was incidentally noted to have diffuse skin crusting. Physical examination showed thick crusts over bilateral feet (especially over the toe webs), trunk, axilla and over the back. Skin scrapings examination showed the presence of scabies. The patient was diagnosed with Norwegian scabies. The absence of scratching allowed accumulation of hyperkeratotic scale crusts with harboring vast numbers of mites. The patient was isolated and managed with Permethrin 5% and brushing with 3% salicyclic acid ointment. The nursing home staff were also advised on the need of washing the clothes and bed linens at 60°C followed by heated drying. Reusable personal items which were non-washable were advised to be placed in a plastic bag and sealed up for at least 14 days before they could be used as usual.
Norwegian Scabies
