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Year : 2022  |  Volume : 67  |  Issue : 1  |  Page : 95
Ancient disease making a comeback due to covid-19 pandemic

Department of Dermatology, Venereology and Leprology, Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, Ambala, Haryana, India

Date of Web Publication19-Apr-2022

Correspondence Address:
Sanjeev Gupta
Department of Dermatology, Venereology and Leprology, Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, Ambala, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijd.ijd_163_21

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How to cite this article:
Gupta S, Gujrathi AV, Gupta S, Yadav A. Ancient disease making a comeback due to covid-19 pandemic. Indian J Dermatol 2022;67:95

How to cite this URL:
Gupta S, Gujrathi AV, Gupta S, Yadav A. Ancient disease making a comeback due to covid-19 pandemic. Indian J Dermatol [serial online] 2022 [cited 2023 May 29];67:95. Available from:


Healthcare in today's world is of utmost significance. A self-explanatory example for this is the ongoing COVID-19 pandemic crisis. It has indicated to the entire world the importance of a sizable investment in healthcare sector. It is of prime importance to understand that healthcare should take into consideration not only the treatment for ailments but also all aspects of propreventive care. Apart from accessibility of health facilities, attitude, awareness, and acceptability is also of paramount importance.

Unfortunately, prioritizing only the Covid cases during the pandemic has caused ignorance and suffering of non-covid patients due to lack of coordination and standard operating procedures (SOPs) during times of crisis. The case highlighted below is a prototype of same. An 8-month-old boy presented with multiple, reddish papules and extensive crusted lesions over back, abdomen, bilateral palms and soles since 3 months. Examination of the baby revealed a cushingoid face with multiple, erythematous scaly papules, and hyperkeratotic crusted papules over trunk, palm and soles [Figure 1]a,[Figure 1]b,[Figure 1]c. On proper examination and history, differentials like seborrheic dermatitis, atopic dermatitis, Norwegian scabies and psoriasis were considered. A pediatric evaluation was sought, which did not find any abnormality in terms of developmental milestones and blood investigations. On enquiry, the parents revealed that they had tested positive for covid-19 a while back and that they were quarantined during which time their baby was in the care of his ailing grandmother who had sought treatment for the baby from local practitioners. The lesions did not resolve and apparently increased. The grandmother of the patient then attempted to consult many higher centers but was unable to do so because of lockdown and closure of hospitals for non-covid illnesses. After their quarantine period, the parents noticed an increase in skin lesions and crusting for which they consulted a general physician who diagnosed him with psoriasis and generalized edema, and was then treated with topical steroids, emollients, and antibiotics without any improvement. The possibility of use of oral steroids could not be ruled out. On further examination, we found that the parents had pruritic erythematous papules with a history of nocturnal itching suggestive of scabies. Skin scrapings taken from the lesions were examined under a microscope, which showed the presence of Sarcoptes scabiei [Figure 2]. A diagnosis of Norwegian scabies was made and the baby was treated with topical emollients and crotamiton 10% lotion twice daily for 2 weeks, as well as topical 6% Sulphur ointment mixed in petrolatum applied only over crusted areas for three consecutive nights. Later, after shedding of crusts and reduction of inflammation, topical permethrin 5% weekly application for 2 weeks was advised (as short contact of 4 hours). Contacts were also treated with oral ivermectin 12 mg once weekly along with permethrin 5% lotion once weekly at night time for 2 weeks. They were further counseled for proper application of medication to a clean and dry skin after bathing followed by washing of clothes and bedding with simultaneous treatment of all contacts due to the contagious nature of disease. All lesions resolved in 3 weeks and no recurrence was seen during 2 months of follow up [Figure 1]d,[Figure 1]e,[Figure 1]f.
Figure 1: (a-c)- Crusted scaly plaque on erythematous background on different parts of the body (pre-treatment). (d-f)- Complete clearance of lesions 3 weeks post-treatment

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Figure 2: Skin scraping showing Sarcoptes scabiei (10 × 40)

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Norwegian or crusted scabies is a highly contagious, severe variant of scabies that can easily trigger an epidemic of scabies. Infantile scabies is often misdiagnosed but its progression and presentation in the form of crusted scabies is rarely heard of.[1] Its risk factors include increased age, dementia, down's syndrome, human immunodeficiency virus infection, leprosy, lymphoma, systemic lupus erythematosus, long-term corticosteroid/immunosuppressants use.[2] None of the above mentioned causes were present in our case. Perhaps, the delay in seeking treatment, misdiagnosis, delayed development of scratch reflex, and past treatment with topical corticosteroids could be possible contributing factors to the increased severity of disease. Recommended treatment for adult Norwegian scabies is oral Ivermectin 120 μg/kg weekly (repeated doses may be required) with or without permethrin lotion due to poor penetrability through thick crusts. Keratolytic agents like salicylic acid can also be used as adjuvants.

This case has been mentioned for the readers to acknowledge the fact that a simple and treatable disease can lead to a dire condition of the patients and their caretakers, simply because of circumstances. Furthermore, the lack of knowledge and awareness not only with parents/relatives/caretakers of the patient but also with the general practitioners and primary healthcare workers is another contributing factor. This case lays focus on lack of general awareness about dermatological diseases among general practitioners and shows the negligent attitude of healthcare workers toward non-covid patients during the pandemic owing to disruption of health services.[3],[4],[5],[6] This is a typical example of how the health crisis due to a particular disease can lead to ignorance of other illnesses. Therefore, to avoid such scenarios, healthcare sector needs to be strengthened by defining health protocols and SOPs for better disaster preparedness thereby preventing distress to patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Baysal V, Yildirim M, Türkman C, Aridogan B, Aydin G. Crusted scabies in a healthy infant. J Eur Acad Dermatol Venereol 2004;18:188-90.  Back to cited text no. 1
Ede C, Gunduz O, Modi D. Crusted scabies in a pediatric renal transplant recipient on immunosuppressants. Transpl Infect Dis 2020;22:e13193.  Back to cited text no. 2
The Lancet. COVID-19: A new lens for non-communicable diseases. Lancet 2020;396:649.  Back to cited text no. 3
Feitosa G. The unapparent Non-COVID consequences of the COVID-19 pandemic. Arq Bras Cardiol 2020;115:871-2.  Back to cited text no. 4
Boeken T, Le Berre A, Mebazaa A, Boulay-Coletta I, Hodel J, Zins M. Non-COVID-19 emergencies: Where have all the patients gone? Eur Radiol 2020;30:5220-1.  Back to cited text no. 5
Martínez-Pallás I, Aldea-Manrique B, Ramírez-Lluch M, Manuel Vinuesa-Hernando J, Ara-Martín M. Scabies outbreak during home confinement due to the SARS-CoV-2 pandemic. J Eur Acad Dermatol Venereol 2020;34:e781-3.  Back to cited text no. 6


  [Figure 1], [Figure 2]


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