|IMAGES IN CLINICAL NEONATOLOGY
|Year : 2014 | Volume
| Issue : 4 | Page : 232-233
Neonatal scabies; An uncommon entity
Chandra Madhur Sharma1, Ravi Prakash Agrawal1, Deepti Sharma2, Geeta Sharma3
1 Department of Paediatrics, Rama Medical College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
2 Department of Obstetrics and Gynaecology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
3 Department of Skin and Venereal Disease, Rama Medical College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
|Date of Web Publication||14-Nov-2014|
Chandra Madhur Sharma
8/218, Flat No. H, Indralok Apartment, Arya Nagar, Kanpur - 208 002, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Clinical presentation of scabies in neonates is unlike that of adults and older children, resulting in missed or delayed diagnosis. The eruptions are generalized, including involvement of the head, neck, face, palms, and soles, with an early tendency to pustule formation. Other lesions include papules, vesicles, and burrows, which may be obliterated by secondary lesions. A confusing clinical picture resulted in a delay in diagnosing scabies in a 25 day old neonate who was successfully treated with permethrin 5% cream.
Keywords: Neonate, scabies, 5% permethrin
|How to cite this article:|
Sharma CM, Agrawal RP, Sharma D, Sharma G. Neonatal scabies; An uncommon entity. J Clin Neonatol 2014;3:232-3
Clinical presentation of scabies in neonates is unlike that of adults and older children, resulting in missed or delayed diagnosis. Neonates do not itch, but present with extensive rashes, irritability, poor feeding, and failure to thrive.  The skin lesions spread rapidly, and involve the face, scalp, palms, and soles. Vesicles are common, leading to early pustulation, crusting, and scaling. 
A number of dermatoses in neonates present as vesicles, pustules, bullae, erosions, and ulcerations during their first 28 days of life. The differential diagnosis included varicella-zoster, other viral exanthema, impetigo, folliculitis, infantile seborrheic dermatitis, and Letterer-Siwe disease.  A type IV hypersensitivity reaction to the mite, its eggs, or its feces develops in the host; this produces severe itching that is the hallmark of scabies. The reaction typically occurs within 4-6 weeks of infestation.  Thus, scabies in neonatal period is not common.
We report the case of a 25-day-old neonate who was diagnosed with scabies and successfully treated with 5% permethrin cream without any adverse effects.
A 25-day-old male infant was brought to us with the complaint of rashes all over the body along with excessive cry, refusal to feed, and fever. On examination small, erythematous macules, papules, nodules, vesicles/bullae, and pustules, some of which were excoriated and surmounted by blood crusts. The distribution of the lesions involved the whole body area, including the face, neck, trunk, palms, and soles [Figure 1]. The lesions over fingers were excoriated and surmounted by blood crust [Figure 2]. He had been admitted to the neonatal intensive care unit with provisional diagnosis of impetigo contagiosa, and was administered injection cefotaxime 150 mg/kg in two divided doses intravenously and mupirocin topically. Despite treatment for 3 days, the skin lesions were not improved rather getting worse, and new lesions were also appeared. Hence, we have consulted to dermatologist of our institute to evaluate his skin manifestations. Based on a careful history and after the microscopic detection of one adult scabies mite and some eggs using the skin scraping method, the diagnosis of scabies was established. According to his mother, some relatives of her had similar illness of itching and pruritic rashes and they touched the baby many times. He was treated with topical 5% permethrin cream once weekly. There was dramatic response after single application of permethrin. The lesions subsided substantially after 3 weeks without relapse. There were no neurologic events suggestive of neurotoxicity. Written consent was obtained from the patient's father for the publication of case report along with photographs.
| References|| |
|1.||Kim KS, Sinniah D, Kee TK. Neonatal rash: A case study. Aust Fam Physician 2012;41:707-9. |
|2.||Nanda S, Reddy BS, Ramji S, Pandhi D. Analytical study of pustular eruptions in neonates. Pediatr Dermatol 2002;19:210-5. |
|3.||Hengge UR, Currie BJ, Jäger G, Lupi O, Schwartz RA. Scabies: A ubiquitous neglected skin disease. Lancet Infect Dis 2006;6:769-79. |
[Figure 1], [Figure 2]