CRUSTED SCABIES OF THE SCALP IN DERMATOMYOSITIS PATIENTS - 3 CASES TREATED WITH ORAL IVERMECTIN

Background Cutaneous features in the scalp area among adult patients a re rarely considered as a manifestation of scabies. Methods Three pati ents with clinical and laboratory data of dermatomyositis with scalp i nvolvement (fulfill three or four of Bohan and Peter's criteria), of 4 years, 8 months, and 3 years duration, were seen at our department be tween 1995 and 1996. For relapses of ordinary scabies, they were treat ed repeatedly with local scabicide with temporary effect. After a symp tom-free period during the treatment of dermatomyositis with corticost eroids and azathioprine, they developed diffuse redness with scales an d crusts on the scalp areas. Light microscopy examination of material taken from these crusts showed an abundance of live mites. Results All patients were successfully cured of scabies with a twice oral dose of 200 mu g/kg ivermectin within 8 days. Conclusions Our patients with c rusted scabies of the scalp and dermatomyositis prompted us to change our standard diagnostic and therapeutic regimens. Fascinating features included mimicry of scabies in patients with dermatomyositis, locatio n of parasites on the scalp, suppressed cell-mediated immunity and suc cessful cure of mange by ivermectin.