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Year : 2017  |  Volume : 18  |  Issue : 2  |  Page : 104-106

A case report of neonatal scabies

Department of Dermatology, GMC, Kota, Rajasthan, India

Date of Web Publication27-Mar-2017

Correspondence Address:
Ramesh Kushwah
Department of Dermatology, GMC, Kota, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2319-7250.203006

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Scabies is commonly seen worldwide, in its usual classic form when afflicting older children and adults. However, neonatal scabies is described as its own entity in the literature. We present a case of a 4-week old infant with a generalized papulopustular, vesicular, and crusted rash who was diagnosed with scabies. We contrast the differing clinical features of neonatal and classic scabies, describe possible mimickers of this diagnostic dilemma, and review current treatment options available for scabies in this very young age group.

Keywords: Neonate, permethrin, rash, scabies, sulfur

How to cite this article:
Singhal AK, Kushwah R, Yadav D, Jain S. A case report of neonatal scabies. Indian J Paediatr Dermatol 2017;18:104-6

How to cite this URL:
Singhal AK, Kushwah R, Yadav D, Jain S. A case report of neonatal scabies. Indian J Paediatr Dermatol [serial online] 2017 [cited 2020 Dec 4];18:104-6. Available from: https://www.ijpd.in/text.asp?2017/18/2/104/203006

  Introduction Top

Human scabies is a mite infestation caused by an obligate Sarcoptes scabiei var. hominis.[1] It induces a marked predominantly nocturnal itching with some papules in typical locations such as flexors folds, cubital margins of hands, anterior side of the wrists, anterior axillae, around nipples and navel, external male genital organs, and internal side of thighs. It affects over 300 million individuals per year worldwide.[2] In developed countries, the incidence is much lower although sexual behavior, immigration, scarce hygiene, and indigence are responsible for some epidemics, especially in adults and elderly. Populations at higher risk are those who live in overcrowded areas and those with poor health, nutrition, and hygiene. Norwegian or crusted scabies is a highly infectious form with a large number of mites infesting the epidermis as a result of the failure of the host immune response [3] or lack of scratching response [4] that conduces to mite removal and burrow destruction.

  Case Report Top

A 4-week-old, previously healthy male infant presented to our skin outdoor patient department for the evaluation of rash. Parents noticed the rash 3 days ago, and it had worsened over the last day. They initially observed small red nodules over the trunk and back, which had spread to include the infant's neck, head, and all of his extremities. The patient's mother also had itchy lesions all over the body. There was no change in behavior or feeding habits.

The baby was born at term via normal vaginal delivery. The prenatal and postnatal laboratory tests of the mother and child, including VDRL and HIV, were negative. Systemic examination was within normal limit.

The infant appeared alert, well nourished, and consolable in his mother's arms. On cutaneous examination, papulopustular and vesicular rash noticed on her chest, abdomen, back, arms, legs, neck, and buttock [Figure 1]. There was a single vesicle on her palm but none on her soles. The pustules and vesicles were located on an erythematous base and in different stages of development, with some containing yellowish fluid and some crusted.
Figure 1: Lesions on back

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All routine investigations were in normal limit. Blood and skin swab cultures, syphilis RPR (rapid plasma reagin), were negative. Skin scrapings revealed scabies egg casings and mite fecal matter, confirming the diagnosis of neonatal scabies.

The treatment regimen recommended was topical application of permethrin 5% cream for 2–4 h, repeated application after 10 days. The family was directed to follow-up closely with the infant's primary care physician. The infant's parents reported no new skin lesions [Figure 2]. On examination, the existing skin lesions were reduced.
Figure 2: Resolution of lesions after treatment

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  Discussion Top

Scabies is known to affect people of all ages.[5] Neonatal scabies is a unique subset with atypical presentations.[6] Both the appearance of the lesions and the areas of involvement are different from classic scabies. Lesions are pleomorphic in the form of papules, pustules, and vesicles.[7],[8] Crusting and secondary bacterial infection of involved skin are commonly seen.[7],[8] Excoriations and burrows are rarely seen.[7] In contrast to classic scabies, neonatal scabies has some salient different features [Table 1]. Pruritus is not exhibited in such a young age group, but neonates can appear fussy with poor feeding and fail to gain weight during active infestation.
Table 1: Difference between classic and neonatal scabies

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Because of the specific presentation seen with neonates, the differential diagnosis is broad and varied [Table 2].[8] The diagnosis of scabies can usually be made clinically after history and examination. Physicians encountering this special population should consider obtaining the microscopic evidence of scabies to confirm clinical suspicion. The most common method of diagnosis through skin scrapings is obtained by scraping a nonexcoriated, inflamed lesion using a scalpel with a round-bellied no. 15 blade and mineral oil.[9] The potential benefits of the procedure outweigh the minimal risk of bleeding. The criterion for diagnosis is the presence of the mite or egg casings under microscopy. The scybala alone is not considered diagnostic as specimen debris can be misinterpreted as mite feces.
Table 2: Differential diagnosis of neonatal scabies

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Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of Interest

There are no conflicts of interest.

  References Top

Burkhart CG, Burkhart CN, Burkhart KM. An epidemiologic and therapeutic reassessment of scabies. Cutis 2000;65:233-40.  Back to cited text no. 1
Orkin M. Scabies: What's new? Curr Probl Dermatol 1995;22:105-11.  Back to cited text no. 2
Roberts LJ, Huffam SE, Walton SF, Currie BJ. Crusted scabies: Clinical and immunological findings in seventy-eight patients and a review of the literature. J Infect 2005;50:375-81.  Back to cited text no. 3
Van Der Wal VB, Van Voorst Vader PC, Mandema JM, Jonkman MF. Crusted (Norwegian) scabies in a patient with dystrophic epidermolysis bullosa. Br J Dermatol 1999;141:918-21.  Back to cited text no. 4
Hicks MI, Elston DM. Scabies. Dermatol Ther 2009;22:279-92.  Back to cited text no. 5
Quarterman MJ, Lesher JL Jr. Neonatal scabies treated with permethrin 5% cream. Pediatr Dermatol 1994;11:264-6.  Back to cited text no. 6
Burns BR, Lampe RM, Hansen GH. Neonatal scabies. Am J Dis Child 1979;133:1031-4.  Back to cited text no. 7
Paller AS. Scabies in infants and small children. Semin Dermatol 1993;12:3-8.  Back to cited text no. 8
Chouela E, Abeldaño A, Pellerano G, Hernández MI. Diagnosis and treatment of scabies: A practical guide. Am J Clin Dermatol 2002;3:9-18.  Back to cited text no. 9


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]


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