Norwegian scabies in a patient with Down syndrome

The article describes a case report of Norwegian scabies in a 36-year-old patient with Down syndrome who lived in a psychiatric nursing home. The diagnosis was made by a dermatovenerologist during an annual periodic medical examination in 2009. There was a total (generalized) skin lesion in the form of erythroderma and massive scales on the forehead and scalp as well as on the distal parts of the upper and lower extremities. On the skin of the trunk and extremities, there were widespread papular elements, erosions, purulent and hemorrhagic crusts, and lichenification. Attention should be paid to the fact that typical scabies was detected a year earlier, which can often occur as in-hospital outbreaks in medical and preventive institutions of this type. The recurrence of the disease could have been caused by inadequate control of the therapy by the patient himself and those around him — other patients in the nursing institution — as well as by poor hygiene habits and specific characteristics of the immune defense of the skin in patients with Down syndrome (such as T- and B-cell lymphopenia, decrease in the specific antibody response to immunization, defects in neutrophil chemotaxis, excessive free radical oxidation of cell membrane lipids, genetically determined by trisomy 21).