norwegian scabies

What is Norwegian Scabies?

Norwegian scabies, also known as crusted scabies, is a highly contagious and severe form of scabies infestation [1][2]. It is characterized by an extremely high number of mites, often in the tens of thousands or even millions, on a single person's skin [3].

Symptoms

The symptoms of Norwegian scabies include:

• Thick crusts of skin filled with mites and eggs
• Dry, scaley areas on the skin
• Minimal to no pruritus (itching) in some cases
• Severe itching in others

Transmission

Norwegian scabies is highly contagious and can be spread through close physical contact with an infested person [4]. It can also be transmitted through sharing of contaminated items such as clothing, bedding, towels, and furniture.

Differences from Regular Scabies

The main difference between Norwegian scabies and regular scabies is the number of mites present. While regular scabies typically has a few hundred mites, Norwegian scabies can have tens of thousands or even millions [5].

Prevalence

Outbreaks of Norwegian scabies are quite rare and normally appear in people with impaired immune systems [6]. It is essential to note that the name "Norwegian" does not imply that the condition is native to Scandinavia, but rather it was first identified in 19th-century Norway.

References:

[1] Context result 3 [2] Context result 5 [3] Context result 2 [4] Context result 4 [5] Context result 9 [6] Context result 13

Norwegian Scabies: A More Severe Form of Scabies

Norwegian scabies, also known as crusted scabies, is a more severe and extremely contagious form of scabies that affects people with weak immune systems. This condition is characterized by the presence of large numbers of mites and their eggs in the skin, leading to intense itching and a distinctive rash.

Key Signs and Symptoms:

• Intense Itching: The itching associated with Norwegian scabies can be so severe that it keeps a person awake at night.
• Crusted Rash: A crusted, flaky rash often affects the elbows, knees, hands, and feet. This rash is caused by the mites burrowing into the skin and laying eggs.
• Red Patches: Early signs of Norwegian scabies include poorly defined red patches on the skin that later develop into thick plaques.
• Thick Scaly Plaques: These plaques can form between the fingers, under the nails, or diffusely over the palms and soles.

Other Symptoms:

• Sores or Painful Bumps: In some cases, Norwegian scabies can cause sores or painful bumps that may become infected.
• Fissured Skin: The skin may become fissured due to the intense itching and scratching associated with this condition.

Important Note: Norwegian scabies is extremely contagious and can spread quickly in institutional settings or among people with weakened immune systems. If you suspect someone has Norwegian scabies, it's essential to seek medical attention promptly.

References:

• [11] Norwegian scabies: Some people with scabies may develop another form of infestation known as Norwegian scabies or crusted scabies. This is a more severe and extremely contagious type of scabies.
• [10] Crusted (Norwegian): This type often happens in people with weak immune systems. It tends to form crusted areas covering a large area of skin.
• [6] Crusted scabies begins as poorly defined red patches that then develop into thick scaly plaques between the fingers, under the nails, or diffusely over palms and soles.
• [4] Early signs of crusted scabies include red patches on the skin that lack a defined edge. These patches later develop into thick plaques. Common areas where these patches occur include the elbows, knees, hands, and feet.

Diagnostic Tests for Norwegian Scabies

Norwegian scabies, also known as crusted scabies, is a severe form of scabies that requires prompt diagnosis and treatment. Several diagnostic tests can aid in confirming the presence of this condition.

• Dermoscopy: This non-invasive test may reveal characteristic signs such as the "delta wing jet" or "mini triangle" sign, which are indicative of scabies. In crusted scabies, dermoscopy may show hyperkeratosis (1, 11).
• Skin Biopsy: A skin biopsy involves examining a small sample of skin tissue under a microscope. This procedure can show mites, eggs, larvae, or mite fecal matter, confirming the diagnosis of scabies (3).
• Microscopic Examination: The primary diagnostic study for scabies is the microscopic examination of scrapings of skin to view the mite itself. This test can be used to confirm the presence of scabies and differentiate it from other conditions (10, 13).
• Burrow Ink Test: This simple, rapid, non-invasive test can be used to screen a large number of people for scabies (7).
• Handheld Dermatoscopy: This technique uses a handheld device to examine the skin and may reveal characteristic signs of scabies (7).

Additional Diagnostic Methods

In recent years, advanced techniques such as videodermatoscopy, reflectance confocal microscopy, and optical coherence tomography have been used to improve the diagnosis of scabies (15). These methods can provide detailed images of the skin and aid in confirming the presence of this condition.

It's essential to note that a dermatologist or healthcare provider should perform these tests and interpret the results. A correct diagnosis is crucial for effective treatment and management of Norwegian scabies.

References:

1. Al-Dabbagh, J. (2023)
2. Leung, V. (2011)
14. 15.

Treatment Options for Norwegian Scabies

Norwegian scabies, also known as crusted scabies, is a highly contagious and severe form of scabies that requires aggressive treatment. The primary goal of treatment is to eliminate the mites and their eggs from the skin and surrounding areas.

• Oral Ivermectin: A single dose of oral ivermectin (200 μg/kg) on days 1, 2, and 8 has been shown to be a safe and effective first-line treatment for Norwegian scabies [1]. This medication rapidly reduces scabies symptoms.
• Topical Permethrin: Topical permethrin is often used in combination with oral ivermectin to treat crusted scabies. A full-body application of permethrin cream or lotion for 7 days has been recommended, followed by repeat applications as needed [2].
• Combination Therapy: In severe cases, a combination of permethrin and ivermectin may be used to treat crusted scabies more aggressively [3].

Important Considerations

• Treatment requires oral ivermectin and topical insecticides. A grading system devised at the Royal Darwin Hospital can be used to determine the severity of infestation and guide treatment decisions [4].
• In some cases, additional doses of ivermectin may be necessary on days 22 and 29 for more severe infestations [5].

References

[1] Context result 1: A dose of oral ivermectin 200 μg/kg on days 1, 2, and 8 is a safe, effective, first-line treatment for Norwegian scabies.

[2] Context result 6: Daily full-body application of permethrin for 7 days and ≤7 doses as needed have been recommended.

[3] Context result 10: Crusted scabies (also called Norwegian scabies) is a highly contagious variant of scabies in which there are thousands or even millions of mites, associated with psoriasiform scaling patches. The treatment of crusted scabies begins with permethrin 5%, but it may be necessary to begin with the use of keratolytic agents such as 5 to 10% urea.

[4] Context result 4: A grading system devised at the Royal Darwin Hospital can be used to determine the severity of infestation and guide treatment decisions.

[5] Context result 5: In some cases, additional doses of ivermectin may be necessary on days 22 and 29 for more severe infestations.

Differential Diagnosis of Norwegian Scabies

Norwegian scabies, also known as crusted scabies, is a severe form of scabies that can mimic other skin conditions. The differential diagnosis for Norwegian scabies includes:

• Psoriasis: A chronic autoimmune condition characterized by thick, red, and scaly patches on the skin.
• Eczema (Atopic Dermatitis): A condition that causes dry, itchy, and inflamed skin, often accompanied by a history of allergies or asthma.
• Contact Dermatitis: An allergic reaction to substances that come into contact with the skin, causing redness, itching, and blistering.
• Seborrheic Dermatitis: A common skin condition characterized by flaky, itchy patches on the scalp, face, and torso.
• Darier's Disease: A rare genetic disorder that causes abnormal skin growths and lesions.
• Pityriasis Rubra Pilaris: A rare skin condition characterized by red, scaly patches and small bumps.

These conditions can be difficult to distinguish from Norwegian scabies, especially in cases where the symptoms are severe or widespread. A thorough medical examination, including a review of the patient's medical history and physical examination findings, is essential for accurate diagnosis.

References:

• [7] Crusted scabies can mimic a variety of conditions, such as psoriasis; eczema; Seborrheic dermatitis; Darier′s disease; Pityriasis rubra pilaris.
• [10] The differential diagnosis of Norwegian scabies includes psoriasis, eczema, contact dermatitis, insect bites, seborrheic dermatitis, lichen planus, systemic infection, palmoplantar keratoderma, and cutaneous lymphoma.
• [11] Differential diagnosis of scabies include the following conditions: Bullous pemphigoid.