These were the fingers of an elderly, bedridden patient in a nursing home, where there was an unexplained outbreak of an itchy rash among the patients and staff. This lady had been thought to have keratoderma due to psoriasis but she had typical scabies elsewhere and examination of scales from her fingers showed scabies mites. This is crusted or Norweigian scabies. She required treatment with Ivermectin orally on two occassions one week apart and several whole body applications of Permethrin cream. Everyone in the nursing home, staff and visitors had to be treated to clean up the outbreak.
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