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March 17, 1975

Scabies and Bullae

JAMA. 1975;231(11):1134. doi:10.1001/jama.1975.03240230010003

To the Editor.—  The recent article (230:878, 1974) regarding the association of scabies and bullae states that "widespread and extensive bullae may on occasion be a part of the clinical spectrum of scabies in children." Whereas it is true that large bullae are sometimes seen in association with scabies, I believe these are a secondary complication of Sarcoptes infestation rather than a primary feature, as seems implied in the article. In most cases, the bullae are most likely due to Staphylococcus aureus superinfection causing bullous impetigo. This seems attested to in the case cited, since an antibiotic was used "because of secondary bacterial infection."Most reports of secondarily infected scabies mention only the clinical nature of such infection as erythema, crusting, pustules, and bullae, but do not specify the particular infecting organism(s). Nowhere have I found a reference mentioning specifically S aureus, phage type 71, as the infecting organism in