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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 74-79

Individualized homoeopathic treatment in a case of crusted scabies


1 Department of Homoeopathic Materia Medica, North Eastern Institute of Ayurveda and Homoeopathy, Shillong, Meghalaya, India
2 Department of Case Taking and Repertory, Mahesh Bhattacharya Homoeopathic Medical College and Hospital, Howrah, West Bengal, India
3 Department of Homoeopathy Hospital, North Eastern Institute of Ayurveda and Homoeopathy, Shillong, Meghalaya, India

Date of Submission13-Jan-2021
Date of Acceptance17-Jan-2021
Date of Web Publication05-Mar-2021

Correspondence Address:
Dr. Himadri Bhaumik
Department of Homoeopathic Materia Medica, North Eastern Institute of Ayurveda and Homoeopathy, Shillong - 793 018, Meghalaya
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AYUHOM.AYUHOM_1_21

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  Abstract 


Crusted scabies or Norwegian scabies, a severe variant of highly contagious scabies, occurs as widespread hyperkeratotic crusted lesions, and hence, the name “crusted scabies” is preferred to the eponym of “Norwegian scabies.” A case of a 27-year-old girl was reported in the Outpatient Department of North Eastern Institute of Ayurveda and Homoeopathy. After thorough case taking and proper repertorisation, mezereum 30C was given as the first prescription. The patient was better and was prescribed placebo for 7 days, and thereafter, appearance of secondary symptoms such as fever, sore throat, and cough had been noticed with no further betterment of skin symptoms. Staphylococcin 200 was used as an intercurrent remedy. After secondary symptoms subsided, again mezereum 30C was given followed by placebo for 1 month, and there was marked improvement. Different stages of the disease were documented and are attached with the detailed case report.

Keywords: Crusted scabies, homoeopathy, intercurrent remedy, mezereum, Staphylococcin


How to cite this article:
Bhaumik H, Sanyal S, Suchiang D. Individualized homoeopathic treatment in a case of crusted scabies. AYUHOM 2019;6:74-9

How to cite this URL:
Bhaumik H, Sanyal S, Suchiang D. Individualized homoeopathic treatment in a case of crusted scabies. AYUHOM [serial online] 2019 [cited 2021 Apr 12];6:74-9. Available from: http://www.ayuhom.com/text.asp?2019/6/2/74/310849




  Introduction Top


Crusted scabies or Norwegian scabies was described by Boeck and Danielssen among lepers in Norway in 1848. It was named as “Scabies Norvegi Boeki” by von Hebra in 1862.[1] Crusted Norwegian scabies is a rare hyperkeratotic variant of scabies infestation by Sarcoptes scabiei var. hominis transmitted through direct skin-to-skin contact with an infected person and through contaminated items such as clothing, bedding, and furniture and has been associated with institutional and health-care facility outbreaks.[2],[3]

The mite is an obligate parasite that lives in burrowed tunnels in the stratum corneum. The female mite lays two-three eggs daily and the eggs hatch in 3–4 days. The young larva passes through the nymphal stage to the mature adult mite stage in 14–17 days. It is estimated that only 10% of the eggs develop into adults.[1] However, in case of crusted scabies, the number of mites is astronomical because of uncontrolled proliferation. The incubation period before the onset of symptoms is 3–6 weeks for primary infestation but may be as short as 1–3 days in reinfestation. It is a severe form of scabies that most often occurs in people who have a weakened immune system or a neurological disease, the elderly, the disabled, or those who are mentally impaired.[4]

Crusted scabies is a severe variant of highly contagious scabies, generally believed that patients with crusted scabies do not itch. However, at least 50% of the patients have some degree of itching.[5]

The eruption is slow in onset and insidious in progression with localized horny plaques and a more distinct erythematous appearance. The plaque is composed of a parakeratotic crust that varies in thickness from about 3–15 mm. The crusts are creamy, gray, yellow brown, or yellow green in color and are adherent and firm but, when removed, they have a porous appearance resembling a pumice stone. The lesions found over the extensor surface show fissuring. On removal of the crust, the undersurface is smooth, red, moist, and velvety in appearance. The lesions of this distinctive form of scabies are extensive and may spread all over the body. Such crusts are seen over the palms, on the extensor aspect of the elbows, on the scalp and ears, and on the soles of the feet and the toes, and the scaly areas eventually take on a wart-like appearance.[1],[6]

A particular danger of crusted scabies is that these lesions often predispose to the development of secondary infections, as with Staphylococcus bacteria.[6],[7],[8]

Diagnosis is based on clinical findings and the demonstration of the mite. Microscopic examination of the skin scrapings from the patient is essential to demonstrate the mites.[8] Standard dermoscopy is a useful tool for diagnosing scabies, with a high sensitivity, even in inexperienced hands.[9]


  Case Report Top


A 27 year old unmarried girl, Christian by religion, belonging to middle socioeconomic family, attended the Outpatient Department of North Eastern Institute of Ayurveda and Homoeopathy, Shillong, Meghalaya, on December 28, 2016, with symptoms of erythematous lesions on the skin of the palmar and dorsal aspect of the right hand with creamy, yellow crust formation which adheres very firmly to the skin below with sticky discharge [Figure 1] and [Figure 2]. There was with slight burning sensation which was relieved by washing with cold water. There was no itching and fever, but stiffness of finger joint was present, which is now being spread to her left hand for 1 month. After scratching, there is discharge of pus and blood. There were no marked physical general and mental general symptoms. She was complaining of much difficulty to perform her daily activities. She had taken direct observation treatment short course for pulmonary tuberculosis 6 years back. By profession, she was an unemployed Bachelor of Arts graduate, no history of unhygienic condition within family members. There was no significant medical/surgical family history.
Figure 1: Crusted scabies before treatment on first visit

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Figure 2: Crusted scabies before treatment on first visit

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On a detailed study and examination of the parts, she was diagnosed as a rare case of crusted scabies.
Figure 3: Crusted scabies during treatment (January 05, 2017)

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Figure 4: Crusted scabies during treatment (January 05, 2017)

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Figure 5: Crusted scabies during treatment (January 20, 2017)

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Figure 6: Crusted scabies during treatment (January 20, 2017)

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Figure 7: Crusted scabies during treatment (January 30, 2017)

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Figure 8: Crusted scabies during treatment (January 30, 2017)

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Figure 9: Crusted scabies during treatment (February 10, 2017)

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Figure 10: Crusted scabies during treatment (February 10, 2017)

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Figure 11: Crusted scabies during treatment (March 11, 2017)

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Figure 12: Crusted scabies during treatment (March 11, 2017)

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Figure 13: Crusted scabies after treatment (April 01, 2017)

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Figure 14: Crusted scabies after treatment (April 01, 2017)

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Figure 15: Crusted scabies after treatment (April 01, 2017)

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Repertorial analysis

Considering the above symptomatology, Synthesis Repertory 9.1 version was selected and RADAR (Archibel, a Zeus Soft company,City- Parc Crealys, Bâtiment Eridan rue Jean Sonet 25, 5032 Isnes - Belgium) software was used for repertorisation.[10] The repertorisation chart is given in [Table 1]. After repertorisation and final consultation with Materia Medica, Mezereum was selected for the subject.[11],[12] She was prescribed mezereum 30C potency in 2 doses, once daily in the morning in empty stomach and placebo 30, 4 globules thrice in a day for 1 week and was instructed to keep the area clean with plain water and also advised to maintain personal hygiene. Follow up and outcome details are given in [Table 2].
Table 1: Repertorisation Chart

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Table 2: Timeline of patient response and medicine prescribed with its dose

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  Results Top


After consulting Materia Medica, the final selected medicine was mezereum and the potency was 30 C. There was much improvement noticed after giving mezereum, but the patient started giving secondary symptoms such as upper respiratory tract infection (fever, sore throat, cough, etc.). As there is a particular danger of crusted scabies, these lesions often predispose to the development of secondary infections, as with Staphylococcus bacteria. Staphylococcin 200C was given as an intercurrent remedy followed by mezereum 30C based on symptom similarity. During the last follow-up, erythematous condition of the skin of the right hand along with formation of crust and pus was stopped with the appearance of fresh healthy skin over the affected parts. Along with the chief complaint, all other associated symptoms of the patient such as burning sensation and stiffness of finger joints also subsided. She was doing her daily activities in a normal way.


  Discussion Top


A rare hyperkeratotic variant of scabies infestation (crusted scabies) and its homoeopathic treatment is mainly through constitutional medicine, i.e., medicine selected is based on characteristic history and totality of the symptoms obtained from complete study of the individual patient. Although concomitant oral and topical scabicidal agent relieves the discomfort, improves cosmetic appearance of the lesions, and prevents further spread of the infection within the patient and to others, it may palliate or even suppress the skin disease leading to more complicated disease of the more important organs of the body. Individualized homoeopathic medicine is the best treatment for these cases.


  Conclusion Top


The diagnosis and treatment of crusted scabies holds a new challenge. Early diagnosis and individualized homoeopathic treatment along with proper treatment protocol may be required. Further case series/clinical trials including controlled double-blinded research work are needed to determine the effectiveness of homoeopathic treatment of the same.

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Karthikeyan K. Crusted scabies. Indian J Dermatol Venereol Leprol 2009;75:340-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Centers for Disease Control and Prevention. Scabies Frequently Asked Questions. USA: Global Health, Division of Parasitic Diseases; 2019. Available from: https://www.cdc.gov/parasites/scabies/gen_info/faqs. [Last accessed on 2020 Mar 12].  Back to cited text no. 2
    
3.
Maghrabi MM, Lum S, Joba AT, Meier MJ, Holmbeck RJ, Kennedy K. Norwegian crusted scabies: An unusual case presentation. J Foot Ankle Surg 2014;53:62-6.  Back to cited text no. 3
    
4.
Kulkarni S, Shah H, Patel B, Bhuptani N. Crusted scabies: Presenting as erythroderma in a human immunodeficiency virus-seropositive patient. Indian J Sex Transm Dis AIDS 2016;37:72-4.  Back to cited text no. 4
    
5.
Roberts LJ, Huffam SE, Walton SF, Currie BJ. Crusted scabies: Clinical and immunological findings in seventy-eight patients and a review of the literature. J Infect 2005;50:375-81.  Back to cited text no. 5
    
6.
Banerji A, Canadian Paediatric Society, First Nations, Inuit and Métis Health Committee. Scabies. Paediatr Child Health 2015; 20:395-402.  Back to cited text no. 6
    
7.
Anbar TS, El-Domyati MB, Mansour HA, Ahmad HM. Scaly scalp associated with crusted scabies: Case series. Dermatol Online J 2007;13:18.  Back to cited text no. 7
    
8.
Dia D, Dieng MT, Ndiaye AM, Ndiaye B, Develoux M. Crusted scabies in Dakar apropos of 11 cases seen in a year. Dakar Med 1999;44:243-5.  Back to cited text no. 8
    
9.
Dupuy A, Dehen L, Bourrat E, Lacroix C, Benderdouche M, Dubertret L, et al. Accuracy of standard dermoscopy for diagnosing scabies. J Am Acad Dermatol 2008;59:530.  Back to cited text no. 9
    
10.
Schroyens Frederik. RADAR 10. Archibel Homoeopathic Software. Archibel, A Zeus Soft company Belgium: 2009.  Back to cited text no. 10
    
11.
Boericke W. New Manual of Homoeopathic Materia Medica with Repertory. 51st Impression: 2011. New Delhi: B. Jain Publishers (P) Ltd.; 2007. p. 442-3.  Back to cited text no. 11
    
12.
Allen HC. Keynotes and Characterstics with Comparisons of Some of the Leading Remedies of the Materia Medica and Nosodes. 1st edition. Kolkata: Modern Homoeopathic Publishers (P) Ltd.; 2012. p. 163-5.  Back to cited text no. 12
    
13.
Close SM. The Genius of Homoeopathy Lectures and Essays on Homoeopathic Philosophy. 2nd edition. New Delhi: B. Jain Publishers (P) Ltd.; 2002. p. 201-2.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15]
 
 
    Tables

  [Table 1], [Table 2]



 

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Case Report
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