Norwegian scabies: alcoholism as a predisposing factor. A case report

Background: Scabies is a dermatosis caused by infection due to Sarcoptes scabiei. An uncommon and severe form of this condition, Norwegian or crusted scabies, has shown an increasing incidence in recent years, due to the growing number of pathologies causing immunosupression. Clinical presentation includes hyperkeratosis and crusted plaques mainly on the skin of the thorax, head, palms and soles. It is easily diagnosed by direct observation of the arhtropode. Permethrin, benzyl benzoate and ivermectin have been described as effective therapeutic resources. Case: A 38-year-old male patient, with previous history of Norwegian scabies treated 2 years ago, and heavy consumption of alcohol is described. Presented illness begins 2 months ago, with the appearance of generalized pruriginous papules which progressively grew into crusted plaques. Physical examination: xerosis cutis, hyperkeratosic plaques in different shapes and sizes, some of them converging, easily removable, on an erytematous, bright, humid base, located on the skin of the neck, torso and limbs. Microscopic examination: eggs and adult forms of Sarcoptes scabiei. Treatment: cefazolin, clorpheniramine, cetirizin, ivermectin. Discussion: Recurrent Norwegian scabies in an adult patient without history of a previous disease, must be a reason to find other causes that jeopardize the individual’s immune response. Besides medical conditions and drugs known to have immunosuppressing effects, habits such as alcohol consumption must be interrogated, for it has been demonstrated that this substance has suppressing effects on innate and acquired immunity. The dermatologic treatment must be complimented with an accurate management of the alcohol abuse which underlies the disease.