Recurrent bullous scabies.
BACKGROUND
scabies is a common infestation that usually presents as a pruriginous eruption consisting of erythematous papules, nodules, and excoriations. Diagnosis relies mostly on clinical features, including the identification of scabietic burrows. Several atypical clinical manifestations have been reported; bullous presentations are particularly rare and intriguing.


OBJECTIVE
a case of recurrent bullous scabies is reported.


RESULTS
an 87-year-old institutionalized woman developed a pruriginous eruption that mimicked bullous pemphigoid. Histopathologic examination revealed blistering at the subepidermal level and a mixed inflammatory infiltrate with numerous eosinophils. Scabies mites were identified on dermoscopy and on skin scrapings, allowing a diagnosis of bullous scabies. Despite effective treatment with topical lindane, failure to control scabies in her institution led to recurrences of her peculiar blistering infestation. Immunofluorescence studies were always negative.


CONCLUSIONS
these observations underscore the mite's role in the pathogenesis of blister formation and illustrate current challenges in scabies' diagnosis and management.
Serra
David
D
Dermatology Department, University Hospital of Coimbra, Portugal. david.serra.fernandes@gmail.com
Pedro Reis
José
J
Mariano
Angelina
A
Machado
Alvaro
A
Figueiredo
Américo
A
D000369:Aged, 80 and over; D001768:Blister / Q000469:parasitology* / Q000473:pathology; D046169:Dermoscopy; D005260:Female; D001556:Hexachlorocyclohexane / Q000627:therapeutic use; D006801:Humans; D007306:Insecticides / Q000627:therapeutic use; D012008:Recurrence; D012532:Scabies / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D012867:Skin / Q000473:pathology
D007306:Insecticides; D001556:Hexachlorocyclohexane