Scabies Mimicing Child Abuse - a Case Report.

Scabies is an infestation of the skin by the mite Sarcoptes scabiei var. hominis that results in an intensely pruritic eruption with a characteristic distribution pattern. The estimated prevalence ranges from 0.2 to 71 percent, with as many as 100 million people affected worldwide (Romani 2015). Transmission of scabies is usually from person to person by direct contact, by wearing or handling heavily contaminated clothing, or by sleeping in an unchanged bed recently occupied by an infested individual. Transmission from parents to children, and especially from mother to infant, is routine. Schools do not ordinarily provide the level of contact necessary for transmission. In young adults, the mode of transmission is usually sexual contact (Fuller 2013, Chosidow 2006, Heukelbach 2006). The essential lesion is a small, erythematous, nondescript papule, often excoriated and tipped with hemorrhagic crusts (Pomares 2014, Eshagh 2014). In other cases scabies can present with unusual forms (e.g. vesicular, bullous, nodular, crusted, urticarial) which can make diagnosis difficult even for experienced dermatologist (Orkin 1985). The diagnosis of scabies is generally made from the history and the distribution of lesions, as well as the skin scraping, dermoscopy, and the adhesive tape test (Mahé 2005, Heukelbach 2005, Walter 2011, Dupuy 2007). Topical permethrin 5% cream and oral ivermectin are the first-line therapies (Chosidow 2006, Heukelbach 2006, Ly 2009). In rare instances there are unusual complications of scabies such as cutaneous vasculitis and glomerulonephritis, which can sometimes overshadow the primary disease (Mazzatenta 1996). Vascular purpura has rarely been reported (Valks 1996, Estève 2001).