Scabies usually presents with intense pruritus and an erythematous papular eruption. Diagnosis and therapy may be difficult owing to atypical morphologic characteristics, including nodules,1 bullae,2 and hyperkeratotic plaques.3 Herein, we describe 2 patients with inherited disorders of keratinization, who presented with severe hyperkeratosis and eosinophilia as the first signs of scabetic infestation. The typical scabetic eruption morphologic changes were not seen. Their pruritus was attributed to the underlying skin disorder. A diagnosis was eventually established through analysis of acral skin scrapings. After the failure of topical permethrin and oral ivermectin in our 2 patients, treatment with 6% and 10% precipitated sulfur in petrolatum was successful, resulting in resolution of the eosinophilia and scabetic infestation.
Sluzevich JC, Sheth AP, Lucky AW. Persistent Eosinophilia as a Presenting Sign of Scabies in Patients With Disorders of Keratinization. Arch Dermatol. 2007;143(5):659-675. doi:10.1001/archderm.143.5.670-b