Hyperkeratotic or crusted scabies, formerly called Norwegian scabies, is caused by the same mite, Sarcoptes scabiei, as common scabies.1 When it was first described by Danielssen and Boeck in 1848 in Norwegian lepers, it was not appreciated as a manifestation of immunodeficiency. Norwegian scabies was seen in those with Down’s syndrome (trisomy 21) or severe mental retardation. It is increasingly being seen in immunocompromised patients of varying types including those with human immunodeficiency virus (HIV) disease, acquired immune deficiency syndrome (AIDS), human T-lymphotropic virus-1 (HTLV-1) associated adult T-cell leukemia/lymphoma,2 chronic lymphocytic leukemia, organ transplantation, patients on treatment with immunosuppressants or systemic steroids, physical debilitation (critical illness, kwashiorkor), and neurological disorders with decreased cutaneous sensation and reduced ability to mechanically remove the mites and destroy the burrows by scratching (tabes dorsalis, syringomyelia, and Parkinson’s disease).
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