title: Bullous scabies: a case report and review of the literature.
abstract: BACKGROUND
  Scabies is a common parasitic infection caused by the mite Sarcoptes Scabiei. About 300 million cases of scabies are reported annually. Scabies usually presents clinically with an erythematous excoriated papulovesicular rash, burrows, nodules and hyperkeratotic lesions in specific body areas. A rare presentation of scabies is the bullous pemphigoid-like bullous scabies. So far, to the best of our knowledge, only 32 cases of bullous scabies have been reported in medical literature, of which only 11 were under 60 years of age at the time of initial presentation. This is the first case of bullous scabies being reported from Pakistan.
  
  
  METHODS
  Herein we discuss, with reference to the existing literature, the case of a 23-year-old Punjabi male who presented with a 3 day history of a tense, non-erythematous, non-tender bulla measuring approximately 0.5 cm x 0.8 cm on the right foot near the interdigital cleft. He was diagnosed to have bullous scabies.
  
  
  CONCLUSIONS
  The diagnosis of scabies should be considered in all patients who present with tense bullous lesions accompanied by pruritus and a maculopapular rash. This is particularly relevant if these lesions do not resolve with steroid treatment. In such patients, in order to prevent a misdiagnosis of bullous pemphigoid, scrapings for Sarcoptes Scabiei mites and eggs should be taken.
authors.affiliation: Aga Khan University, Stadium Road, Karachi, Pakistan. marslanarif@ymail.com.
authors.forename: Muhammad Arslan Arif
authors.initials: MA
authors.lastname: Maan
authors.affiliation: Aga Khan University, Stadium Road, Karachi, Pakistan. sobanmaan@live.co.uk.
authors.forename: Muhammad Soban Arif
authors.initials: MS
authors.lastname: Maan
authors.affiliation: Aga Khan University, Stadium Road, Karachi, Pakistan. ameer.hamzasohail@gmail.com.
authors.forename: Abdul Malik Amir Humza
authors.initials: AM
authors.lastname: Sohail
authors.affiliation: Department of Dermatology, Punjab Medical College, Faisalabad, Pakistan. afmaan@hotmail.com.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Arif
mesh_terms: D000818:Animals; D003937:Diagnosis, Differential; D005076:Exanthema / Q000175:diagnosis* / Q000469:parasitology / Q000473:pathology; D006801:Humans; D008297:Male; D010154:Pakistan; D010391:Pemphigoid, Bullous / Q000175:diagnosis* / Q000469:parasitology / Q000473:pathology; D012520:Sarcoptes scabiei / Q000472:pathogenicity / Q000502:physiology; D012532:Scabies / Q000175:diagnosis* / Q000469:parasitology / Q000473:pathology; D055815:Young Adult