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to 1-3 per cm

2

, no mobile mites were found. Tape 

tests taken from the skin surface and the sheets 

were negative. The following therapy included 

desensitizing (sodium thiosulfate) and antihistamine 

(chlorpheniramine) drugs, as well as topical application 

of emollients (cold cream).

DISCUSSION

The analysis of the 5 clinical cases allows scabious 

erythroderma to be singled out as a separate rare form 

of scabies. The clinical diagnostic criteria of this form 

are as follows:

•  Development of the disease on the background 

of taking medicines which reduce itch, such as 

systemic and topical corticosteroids, psychotropic, 

antihistamine and desensitizing drugs. The 

suppression of itch reduces scratching thus 

preserving mites in the skin. So the population of 

mites is uncontrolledly increasing.

•  Considerable duration of the disease (> 8 months) 

with early erythroderma appearing 2-3 months after 

administering systemic and topical corticosteroids, 

often in combination with antihistamine and/or 

psychotropic drugs.

•  Peculiar character of itch: less severe, diffuse, 

increasing in the evening, without scratch marks. 

Patients usually do not scratch but rather rub the 

skin with their hands.

•  Generalized erythema with infiltration 

(erythroderma) and xerosis with minimal scaling.

•  Areas of hyperkeratosis on the sites of constant 

pressure (buttocks, elbows).

•  Crusts are absent.

•  Presence of only small pustules with slight 

infiltration at the base (osteofolliculitis).

•  A great number of burrows at the sites of preferable 

localization (hands, wrists, feet): 50-310 in an 

anatomic region.

•  Presence of burrows on the face, neck and in the 

interscapular region where they are usually absent 

in case of common scabies.

•  Prevalence of the so-called metamorphic burrows 

(2-3 mm long) which are mostly made by immature 

parasites (larvae, nymphs) [5].

•  Persistent white dermographism.

•  Mites are visualized by dermatoscopy not only in 

burrows but also on erythrodermic as well as on 

apparently normal skin.

•  All persons in contact with the patient are infested.

Scabious erythroderma is a rare clinical form of scabies. 

In fact, this form precedes Norwegian scabies which is 

mainly characterized by erythroderma and multiple crusts. 

Since scabious erythroderma has not been previously 

singled out as a separate form of scabies, many authors 

regard it as Norwegian scabies taking hyperkeratotic layers 

for crusts to which the former do not belong. Since the 

data of medical literature obtained by means of electron 

microscopy and cultural analyses confirm the colonization 

of burrows in Norwegian scabies by Staphylococcus aureus, 

it can be assumed that, in the first stage, this agent acts 

as a superallergen causing an allergic reaction which 

reminds reactions in drug eruption, atopic dermatitis 

(Hill’s erythroderma), psoriasis, and other skin diseases. 

This reaction is then followed by a severe exudation and 

massive multilayer crusts are formed, often on the sites 

where burrows are located. In this case we deal with 

Norwegian or crusted scabies.

Norwegian or crusted scabies and scabious erythroderma 

have many features in common:

•  Both forms appear on the background of conditions 

considerably reducing itch, which contributes to a 

rapid growth of mite colonization of the patient.

•  Intense erythroderma is one of the diagnostically 

relevant criteria in both cases.

•  Sites affected are the face, neck and scalp.

•  Multiple burrows are present in sites of their typical 

localization (hands, wrists, feet, elbows, male 

genitalia).

•  On the background of erythroderma follicular 

papules are present in the areas of apparently normal 

skin; lenticular papules are found on male genitalia 

and, in both sexes, in axillar pits, on the abdomen 

and buttocks; besides, a small number of vesicles 

are seen on hands and feet.

•  Microepidemics arise around such patients: infested 

are family members, medical personnel and other 

patients sharing the same ward.

However, there are some significant differences 

between these two forms of scabies which are listed 

in Table 3. They are helpful for making differential 

diagnosis between Norwegian scabies and scabious 

erythroderma.

The first place in the diagnostic efficacy belongs 

to dermatoscopy, the second - to microscopy of 

epidermal scrapings and the third one - to tape-tests. 

Our experience shows that in patients with common 

scabies mites are extremely rarely detected by means 

of tape-tests.

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The examination of bed linen used by patients 

with scabious erythroderma demonstrates high 

contagiousness of this scabies form. Hence, on 

admission of such patients to hospital, or while treating 

them at home, their underwear and bed linen must be 

daily disinfected.

CONCLUSION

This is the description of a rare clinical form of scabies, 

scabious erythroderma. It is based on the analysis of the 

5 cases of scabies, whose main clinical manifestation 

is diffuse erythroderma. The diagnostic criteria of 

scabious erythroderma and differential diagnosis of 

Norwegian scabies are given. The invasive potential of 

this form of the disease on the patient and beyond is 

evaluated for the first time.

STATEMENT OF HUMAN AND ANIMAL 
RIGHTS 

All procedures followed were in accordance with the 

ethical standards of the responsible committee on 

human experimentation (institutional and national) 

and with the Helsinki Declaration of 1975, as revised 

in 2008. 

STATEMENT OF INFORMED CONSENT 

Informed consent was obtained from all patients for 

being included in the study.

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Table 3:

 Differential diagnostics of Norwegian scabies and scabious erythroderma

Features

Norwegian scabies

Scabious erythroderma

Most frequent causes

Immunosuppression connected with long-term use of 
hormones and cytostatics in case of organ transplants and 
severe diseases (leukemias, Bloom syndrome, systemic 
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Itch 

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Weak, diffuse. Patients usually do not scratch but rather 
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Main clinical symptom

Multiple massive crusts on the background of erythroderma

Only erythroderma

Onset of erythroderma

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2

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Typical mite burrows, 5-7 mm long, prevail

Short burrows, 2-3 mm long, prevail which are made by 
immature parasites

Affection of nails

Often

Absent

Lymphadenopathy

Practically always present

Absent

Increased body temperature

Often

Absent

Changes of hair colour, alopecia

Often

Uncommon

Malodour of the body

Frequent symptom

Absent

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Confl ict of Interest:

 None declared.