Crusted scabies in a patient with lepromatous leprosy.

Crusted scabies (CS) is a very contagious rare skin infestation caused by Sarcoptes scabiei var hominis, an obligate human parasite, transmitted by skin-to-skin contact.1 Clinically, it can present with psoriasiform skin lesions in acral distribution with variable whitish scaling. It usually involves the subungueal area with nail hyperkeratosis and dystrophy.2 A 56-year-old man, alcoholic, presented with a seven-month history of pruritus (with nocturnal exacerbation), weight loss and muscle weakness. The patient is a known case of lepromatous leprosy (LL), diagnosed 22 years ago with irregular treatment, neurological damage and deformities. On examination, hyperkeratosis with crusted lesions on hands and feet with severe nail dystrophy. We also noted an erythematous scaling eruption in the face, neck, scalp, trunk, and arms (Fig. 1). Laboratory results included