title: Crusted scabies of the scalp in a patient with systemic lupus erythematosus.
abstract: BACKGROUND
  Crusted scabies is a severe, hyperkeratotic, psoriasiform disorder associated with immune suppression. Affected individuals typically present with crusted hyperkeratotic lesions in a variety of locations. This condition can lead to severe complications: institutional outbreaks and secondary bacterial infections associated with sepsis and high mortality.
  
  
  METHODS
  A 37-year-old woman with a 12-year history of systemic lupus erythematosus treated with prednisone, methotrexate, and plaquenil presented with a three-week history of a painful scalp rash with adherent yellow scale. Skin biopsy and tissue culture were consistent with a diagnosis of crusted scabies with superficial bacterial infection. The patient was treated with oral ivermectin and permethrin cream, as well as ciprofloxacin for the bacterial infection. At one-week follow-up, the scalp was no longer tender and hyperkeratotic plaques had significantly improved. At one-month follow-up, the affected scalp demonstrated further improvement with decreasing erythema and alopecia with follicular ostia.
  
  
  CONCLUSIONS
  Our case highlights the atypical presentation of crusted scabies with primary scalp involvement and need for vigilance in recognizing and appropriately treating this condition to prevent the consequences of longstanding infection. Combination treatment with ivermectin and permethrin is appropriate management for this condition.
authors.forename: Brittany E
authors.initials: BE
authors.lastname: Yee
authors.forename: Casey A
authors.initials: CA
authors.lastname: Carlos
authors.affiliation: University of California, San Diego. thata@mail.ucsd.edu.
authors.forename: Tissa
authors.initials: T
authors.lastname: Hata
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000977:Antiparasitic Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D016972:Enterobacter cloacae; D004756:Enterobacteriaceae Infections / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007559:Ivermectin / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D026023:Permethrin / Q000627:therapeutic use; D012532:Scabies / Q000150:complications* / Q000188:drug therapy; D012536:Scalp Dermatoses / Q000150:complications* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D000977:Antiparasitic Agents; D026023:Permethrin; D002939:Ciprofloxacin; D007559:Ivermectin