Cohen Philip R, Crowley Christopher, Erickson Christof, Calame Antoanella
Dermatology, San Diego Family Dermatology, National City, USA.
Dermatology, Compass Dermatopathology, San Diego, USA.
Cureus. 2020 Aug 3;12(8):e9542. doi: 10.7759/cureus.9542.
Sarcoptes scabiei classically presents with pruritic burrows. In addition to finger and toe web lesions, the penis and scrotum of men, the breast and areola of women, and the buttocks and axillae of both gender are common locations for mite-associated lesions. Scabies surrepticius refers to mite-related lesions that are not classical in morphology and/or distribution; there are several subtypes of non-classic or atypical scabies. Scabies surrepticius not only occurs in immunosuppressed individuals, but also in infants and children, and in elderly patients. An elderly woman developed mite-related bilateral erythematous painful palmar pustules that were clinically suspicious for a primary neutrophilic dermatosis; she also had a concurrent bacterial infection. The diagnosis of surrepticius scabies was established after evaluation of the deeper levels of her tissue biopsy specimen demonstrated a mite in the epidermis. All of her symptoms and lesions resolved after treatment with oral and topical antiscabetic therapy, and systemic antibiotics. Since the clinical presentation of the mite-related lesions can mimic those of other dermatologic or systemic conditions, a high degree of suspicion for the diagnosis of mite infestation must be entertained. Therefore, the clinician should consider the possibility of scabies surrepticius in any patient who develops new cutaneous lesions that are not typical for a defined dermatosis or do not resolve or improve after treatment.
疥螨通常表现为瘙痒性隧道。除了手指和脚趾间的皮损外，男性的阴茎和阴囊、女性的乳房和乳晕以及男女两性的臀部和腋窝都是与螨虫相关皮损的常见部位。隐匿性疥疮是指形态和/或分布不典型的与螨虫相关的皮损；存在几种非典型疥疮的亚型。隐匿性疥疮不仅发生在免疫抑制个体中，也发生在婴儿、儿童和老年患者中。一名老年女性出现了与螨虫相关的双侧手掌红斑性疼痛脓疱，临床上怀疑为原发性嗜中性皮病；她还同时患有细菌感染。在对其组织活检标本的深层进行评估显示表皮中有螨虫后，确诊为隐匿性疥疮。在接受口服和外用抗疥疮治疗以及全身抗生素治疗后，她所有的症状和皮损都消失了。由于与螨虫相关的皮损的临床表现可能与其他皮肤病或全身性疾病相似，因此必须高度怀疑螨虫感染的诊断。因此，对于任何出现非典型特定皮肤病皮损或治疗后未消退或改善的新皮肤病变的患者，临床医生都应考虑隐匿性疥疮的可能性。
