This man with three month history of generalised pruritic eruption and a positive family history of scabies had been treated as case of eczema with oral and topical steroids by a general practitioner.  KOH preparation of the hyperkeratotic scaly plaques confirmed the diagnosis of crusted scabies and he was successfully treated with topical scabicide.  All the family members were also treated.

Crusted or Norwegian scabies was described in 1848 by Danielssen and Boeck as a severe form of human scabies characterized by the presence of thick crusted lesions containing a large number of parasites.  Crusted scabies usually develops in patients with defective T-cell immune response, or reduced cutaneous sensibility due to physical or mental debilitation.  Scabies can develop in association with transplantation, AIDS, T-cell leukemia or lymphoma and has been observed in patients with systemic lupus erythematosus, and dermatomyositis. Crusted scabies was also described in otherwise healthy individuals using potent topical coricosteroids.