Crusted scabies in patients with long-term use of oral corticosteroid with different underlying diseases - case series

People with a weakened immune system may develop the severe form of scabies called crusted scabies. We have two cases of female patients with history of using long-term oral corticosteroid and then developing scabies infection. The first patient had other comorbidities which caused her become more susceptible while the second patient had been diagnosed with bullous pemphigoid. Both patients complained thick crust on some parts of their bodies, accompanied with itchy papules. Based on microscopic examination from lesion scraping, we found the adult form of sarcoptes scabiei and crusted scabies diagnosis was established. The lesions were improving when they got combination of topical sulfur precipitate, salicylic acid, and permethrine 5%. Crusted scabies is characterized by hyperkeratosis and crusting of the skin due to the profuse proliferation of mites resulting from an altered host response. Combination of topical antiscabies and keratolytic can make the crusts thinner and improve topical absorption.