Unexpected subungual Sarcoptes infestation of toenail - a case report and literature review.

Scabies is the skin infestation caused by Sarcoptes scabiei var hominis. It is one of the commonest dermatological infection which can affect people around the world. However, nails are relatively rarely involved, and the fingernails are mostly infected. The report a case of a 77-year-old woman, long-term pensioner of a nursing home, who had isolated toe subungual Sarcoptes infestation. In addition, the results of systematic review of toenails scabies was presented. Analysis of 21 subungual Sarcoptes infestation cases, revealed that patients in any age (median age 45+/-31.7-year-old) and sex can be affected. Most of the patients had concomitant diseases. Seventy-five percent of cases of nail involvement were treated with combined or sequential therapy. The most used drugs were ivermectin (IVR) and permethrin (PER) (each used in 47.6% cases), following γ-BHC (38.1%) and crotamiton (CRO) (23.8%). It seems that the crucial for adequate diagnosis in scabies affected nails is a precise anamnesis, early and accurate diagnosis that consists of examining not only skin lesions, but including assessing toenails, and differentiation of Sarcoptes infestation from other nail diseases as onychomycosis or psoriasis. Important to achieving a cure is at least frequent nail trimming, softening the nail plate with urea or in the difficult cases the mechanical removal of subungual plaque with using of a scabicide in the location allowing to penatrate it under the nail plate.