Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature

L Roberts, S Huffam, S Walton,, Bart Currie

Research output: Contribution to journalArticlepeer-review


Objectives: To describe the clinical and immunological features of crusted scabies in a prospectively ascertained cohort of 78 patients. Methods: All patients requiring inpatient treatment for crusted scabies in the 'top end' of the northern territory of Australia over a 10 year period were prospectively identified. Demographics, risk factors, and immunological parameters were retrospectively compiled from their medical records and pathology databases. Results: More than half the patients with crusted scabies had identifiable immunosuppressive risk factors. Eosinophilia and elevated IgE levels occurred in 58% and 96% of patients, respectively, with median IgE levels 17 times the upper limit of normal. Seventeen percent had a history of leprosy but 42% had no identifiable risk factors. There was a decrease in mortality after the introduction of a treatment protocol consisting of multiple doses of ivermectin combined with topical scabicides and keratolytic therapy. Conclusions: Crusted scabies often occurs in patients with identifiable immunosuppressive risk factors. In patients without such risk factors, it is possible that the crusted response to infection results from a tendency to preferentially mount a Th2 response. The treatment regime described was associated with a reduction in mortality. This is the largest reported case series of crusted scabies. � 2004 The British Infection Society. Published by Elsevier. Published Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)375-381
Number of pages7
JournalJournal of Infection
Issue number5
Publication statusPublished - 2005


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