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June 1987

Diabetic Patient With Crusted Plaques

Author Affiliations

Texas Tech University Health Sciences Center, Lubbock

Arch Dermatol. 1987;123(6):811-812. doi:10.1001/archderm.1987.01660300133026

REPORT OF A CASE  A 56-year-old woman with a history of diabetes mellitus, hypertension, and chronic renal failure secondary to these conditions presented with presumed seizure activity. She was hospitalized for evaluation. Our department was consulted concerning a "severe rash over the thorax and all four extremities" (Figs 1 and 2). The patient stated that she had experienced a gradual worsening of her skin condition over a 13-month period. There was no associated pruritus. Her family members had no history of a similar skin problem.Diagnostic procedures were performed, and a skin biopsy specimen is shown in Fig 3.What is your diagnosis?

DIAGNOSIS:  Crusted (Norwegian) scabies.

DISCUSSION  Infestation of the mite Sarcoptes scabiei represents the well-known condition called scabies. The females burrow into the stratum corneum to lay eggs. This act usually causes the classic clinical picture of linear burrows in the skin. The typical distribution involves the interdigital spaces of the fingers