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Subungual and ungual scabies: avoiding severe presentation in high-risk patients
  1. Omer Last1,
  2. Jensen Reckhow2,
  3. Ben Bogen1 and
  4. Mati Rozenblat3
  1. 1 Dermatology and Venereology, Soroka University Medical Center, Beer Sheva, Israel
  2. 2 Medical School for International Health at Ben-Gurion University of the Negev, Beer-Sheva, Israel
  3. 3 Dermatology, Emek Medical Center, Afula, Israel
  1. Correspondence to Jensen Reckhow, reckhow{at}


Scabies is a pruritic disorder caused by Sarcoptes scabiei var. hominis infestation of the skin. Transferred by close body contact, scabies is endemic within nursing homes and among poor and overcrowded populations. Crusted scabies is a severe form of disease, characterised by a large, thick, crusted eruption with significant mite infestation. We report a patient hospitalised with crusted scabies that had massive nail involvement. A 79-year-old female patient with multiple comorbidities and several recent prior scabies diagnoses presented with agitation and dystrophic fingernails; scabies mites were found embedded in and below the nail keratin. Aggressive treatment resulted in complete resolution, with notable improvements in mental status. Crusted scabies with nail involvement is extremely rare and may be more likely to develop from initially subclinical infestation sites. It is important to consider this potential presentation, as standard topical treatments may prove ineffective when there is deep nail involvement.

  • dermatology
  • infections
  • skin

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  • Contributors JR takes responsibility for planning, conducting and reporting the work. BB and OL managed the patient. OL, JR and MR completed all relevant analyses and prepared the manuscript for submission. OL, JR, BB and MR agree to be accountable for all aspects of the work presented in this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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