JMIR Publications

ABSTRACT

Background:

Teledermatology (TD) has been available for some years now, but the COVID-19 pandemic has highlighted its importance, especially in remote communities. Crusted scabies (CS) displays a unique clinical picture that favours telediagnosis. Patients suffering from neurological diseases are at risk, as well as homeless HIV-infected patients and people with impaired immunological function. Clusters of CS have been reported in French Guyana in association with HTLV infections and also in Aboriginal Australian communities.

Objective:

Teledermatology is especially useful in cases of crusted scabies as it is a disease that affects areas in need of medical services and, at the same time, it exhibits a unique clinical picture. The objective of this presentation is to fuel clinical suspicion and detection on patients suffering from this debilitating condition.

Methods:

Relatives of patient-1 contacted our clinic for teledermatology appointments. General practitioners from health service sent images of the second patient.

Results:

Case1- Elderly woman living in a nursing home and suffering from Alzheimer’s disease, severe enough to constrain her to bed. We recommended her relatives (who had sent the images of Figure 1a, 1b) to collect skin scrapings in a container, which were sent to a clinical analysis laboratory where microscopic KOH preparation revealed the presence of large numbers of Sarcoptes (1c). Treatment with oral ivermectin and topical permethrin resulted in complete resolution of the lesions (1d). Case 2- Homeless HIV positive 42-year-old male. The images were sent by clinicians of local health service and are depicted in figure2 He was also treated with oral ivermectin plus permethrin lotion. We recognize that this case would need further diagnostic work-up but it is highly compatible with CS.

Conclusions:

CS is one of the most suited diseases for the practice of TD for widespread large hyperkeratotic fissured plaques covered with abundant silvery scales where the expression “once seen, never forgotten” is highly applicable. These cases are gratifyingly simple to treat and patients benefit from rapid clinical improvement. Prompt diagnosis prevents outbreaks of scabies for the relatives and medical personnel, since these skin crusts contain large numbers of scabies mites. CS have been increasingly reported, but yet poorly recognized and often misdiagnosed as psoriasis.