Severe Scabies: A French Multi-centre Study Involving 95 Patients with Crusted and Profuse Disease and Review of the Literature


  • Charbel Skayem Dermatology Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France
  • Askour Majda Dermatology Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France
  • Charlotte Gary Dermatology Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France
  • Francois Hemery Service d’Information Médicale, DSIGHM, APHP, Hôpital Henri-Mondor, Créteil, France
  • Emmanuel Mahé Dermatology Department, Centre Hospitalier Victor Dupouy, Argenteuil, France
  • Frederic Caux Dermatology Department, APHP, Hôpital Avicenne, Bobigny, France
  • Nicolas Dupin Dermatology Department, APHP, Hôpital Cochin, Pavillon Tarnier, Paris, France
  • Patricia Senet Dermatology Department, APHP, Hôpital Tenon, Sorbonne Université, Paris, France
  • Alix Greder-Belan Service de Médecine Interne et Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Versailles, Hôpital Mignot, Le Chesnay, France
  • Brigitte Hillion Dermatology Department, Centre Hospitalier Marne la Vallée, Jossigny, France
  • Cecile Meni Dermatology Department, APHP, Hôpital Necker-Enfants malades, Paris, France
  • Philippe Saiag Dermatology Department, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
  • Guillaume Bellaud Infectious Diseases Department, APHP, Hôpital Tenon, Hôpitaux Universitaires Paris-Est, Paris, France
  • Alexandre Bleibtreu Infectious Diseases Department, APHP, Hôpital Bichat Claude Bernard, Paris, France
  • Sylvie Lariven Infectious Diseases Department, APHP, Hôpital Bichat Claude Bernard, Paris, France
  • Diane Bollens Infectious Diseases Department, APHP, Hôpital Saint-Antoine, Paris, France
  • Vincent Descamps Dermatology Department, APHP, Hôpital Bichat Claude Bernard, Paris, France
  • Jean-Michel Molina Infectious Diseases Department, APHP, Hôpital Saint-Louis, Paris, France
  • Olivier Bouchaud Infectious Diseases Department, APHP, Hôpital Avicenne, Bobigny, France
  • Daniel Vittecoq Infectious Diseases Department, APHP, CHU Bicêtre, Le Kremlin Bicêtre, France
  • Gia Do-Pham Service de Médecine Interne, Centre Hospitalier Intercommunal de Créteil, Créteil, France
  • Francoise Foulet Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
  • Francoise Botterel Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
  • Olivier Chosidow Dermatology Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France
  • Charlotte Bernigaud Dermatology Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France



scabies, Sarcoptes scabiei, parasitic, crusted scabies, pruritus, ivermectin, permethrin


The aim of this multi-centre French retrospective study was to identify severe, i.e. crusted and profuse, scabies patients. Records were retrieved from 22 Dermatology or Infectious Diseases departments in the Ile-de-France from January 2009 to January 2015 to characterize epidemiology, demography, diagnosis, contributing factors, treatment features, and outcomes in severe scabies. A total of 95 inpatients (57 crusted and 38 profuse) were included. A higher number of cases was observed among elderly patients (>75 years), mostly living in institutions. Thirteen patients (13.6%) reported a history of previously treated scabies. Sixty-three patients (66.3%) had been seen by a previous practitioner for the current episode (up to 8 previous visits). Initial misdiagnosis (e.g. eczema, prurigo, drug-related eruptions, psoriasis) was documented in 41 patients (43.1%). Fifty-eight patients (61%) had already received 1 or more previous treatments for their current episode. Forty percent received corticosteroids or acitretin for an initial diagnosis of eczema or psoriasis. Median time from the onset of symptoms to the diagnosis of severe scabies was 3 months (range 0.3–22). Itch was present in all patients at diagnosis. Most patients (n=84, 88.4%) had comorbidities. Diagnostic and therapeutic approaches varied. Complications occurred in 11.5% of cases. To date, there is no consensus for diagnosis and treatment, and future standardization of is required for optimal management. 


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Thomas C, Coates SJ, Engelman D, Chosidow O, Chang AY. Ectoparasites: scabies. J Am Acad Dermatol 2020; 82: 533-548. DOI:

Bernigaud C, Monsel G, Delaunay P, Chosidow O. Arthropods. In: C. Griffiths, J. Barker, T. Bleiker, R. Chalmers, D. Creamer, editors. Rook's textbook of dermatology. Wiley, 2022, 10th edn.

Niode NJ, Adji A, Gazpers S, Kandou RT, Pandaleke H, Trisnowati DM, et al. Crusted scabies, a neglected tropical disease: case series and literature review. Infect Dis Rep 2022; 14: 479-491. DOI:

World Health Organization (WHO). Scabies. Geneva: World Health Organization, 2015. [Accessed 31/01/2022] Available from

Chosidow O. Clinical practices. Scabies. N Engl J Med 2006; 354: 1718-1727. DOI:

Cinotti E, Perrot JL, Labeille B, Vercherin P, Chol C, Besson E, Cambazard F. Reflectance confocal microscopy for quantification of Sarcoptes scabiei in Norwegian scabies. J Eur Acad Dermatol Venereol 2013; 27: e176-8. DOI:

Roberts LJ, Huffam SE, Walton SF, Currie BJ. Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature. J Infect 2005; 50: 375-381. DOI:

Davis JS, McGloughlin S, Tong SY, Walton SF, Currie BJ. A novel clinical grading scale to guide the management of crusted scabies. PLoS Negl Trop Dis 2013; 7: e2387. DOI:

Yélamos O, Mir-Bonafé JF, López-Ferrer A, Garcia-Muret MP, Alegre M, Puig L. Crusted (Norwegian) scabies: an under-recognized infestation characterized by an atypical presentation and delayed diagnosis. J Eur Acad Dermatol Venereol 2016; 30: 483-485. DOI:

O'Donnell BF, O'Loughlin S, Powell FC. Management of crusted scabies. Int J Dermatol 1990; 29: 258-266. DOI:

Hasan T, Krause VL, James C, Currie BJ. Crusted scabies; a 2-year prospective study from the Northern Territory of Australia. PLoS Negl Trop Dis 2020; 14: e0008994. DOI:

De Sainte Marie B, Mallet S, Gaudy-Marqueste C, Baumstarck K, Bentaleb N, Loundou A, et al. Gales en échec de traitement: étude observationnelle. Ann Dermatol Venereol 2016; 143: 9-15. DOI:

Hay RJ, Steer AC, Engelman D, Walton S. Scabies in the developing world - its prevalence, complications, and management. Clin Microbiol Infect 2012; 18: 313-323. DOI:

Engelman D, Yoshizumi J, Hay RJ, Osti M, Micali G, Norton S, et al. The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies. Br J Dermatol 2020; 183: 808-820. DOI:

Sandre M, Ralevski F, Rau N. An elderly long-term care resident with crusted scabies. Can J Infect Dis Med Microbiol 2015; 26: 39-40. DOI:

Gach J, Heagerty A. Crusted scabies looking like psoriasis. Lancet 2000; 356: 650. DOI:

Fonseca V, Price HN, Jeffries M, Alder SL, Hansen RC. Crusted scabies misdiagnosed as erythrodermic psoriasis in a 3-year-old girl with Down syndrome. Pediatr Dermatol 2014; 31: 753-754. DOI:

Murugaiyan R, Sengottian KLB, Karthikeyan K. Crusted scabies presenting as palmoplantar psoriasis in Down's syndrome. Indian Dermatol Online J 2015; 6: 140-141. DOI:

Kutlu NS, Turan E, Erdemir A, Gürel MS, Bozkurt E. Eleven years of itching: a case report of crusted scabies. Cutis 2014; 94: 86-88.

Hong MY, Lee CC, Chuang MC, Chao SC, Tsai MC, Chi CH. Factors related to missed diagnosis of incidental scabies infestations in patients admitted through the emergency department to inpatient services. Acad Emerg Med 2010; 17: 958-964. DOI:

Askour M, Kissou A, Lyagoubi M, Hassam B. Gale hyperkératosique mimant un eczéma : difficultés diagnostiques devant des lésions croûteuses chroniques. Presse Med 2016; 45: 1193-1194. DOI:

Almond DS. Lesson of the week Norwegian scabies misdiagnosed as an adverse drug reaction. BMJ 2000; 320: 35-36. DOI:

Costa JB, Rocha de Sousa VL, da Trindade Neto PB, Paulo Filho Tde A, Cabral VC, Pinheiro PM. Norwegian scabies mimicking rupioid psoriasis. An Bras Dermatol 2012; 87: 910-913. DOI:

Das A, Bar C, Patra A. Norwegian scabies: rare cause of erythroderma. Indian Dermatol Online J 2015; 6: 52-54. DOI:

Goyal NN, Wong GA. Psoriasis or crusted scabies. Clin Exp Dermatol 2008; 33: 211-212. DOI:

Burch JM, Krol A, Weston WL. Sarcoptes scabiei infestation misdiagnosed and treated as Langerhans cell histiocytosis. Pediatr Dermatol 2004; 21: 58-62. DOI:

Walton SF, McBroom J, Mathews JD, Kemp DJ, Currie BJ. Crusted scabies: a molecular analysis of Sarcoptes scabiei variety hominis populations from patients with repeated infestations. Clin Infect Dis 1999; 29: 1226-1230. DOI:

Hewitt KA, Nalabanda A, Cassell JA. Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England. Epidemiol Infect 2015; 143: 1542-1551. DOI:

Cassell JA, Middleton J, Nalabanda A, Lanza S, Head MG, Bostock J, et al. Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes. Lancet Infect Dis 2018; 18: 894-902. DOI:

De Beer G, Miller MA, Tremblay L, Monette J. An outbreak of scabies in a long-term care facility: the role of misdiagnosis and the costs associated with Control. Infect Control Hosp Epidemiol 2006; 27: 517-518. DOI:

Makigami K, Ohtaki N, Ishii N, Tamashiro T, Yoshida S, Yasumura S. Risk factors for recurrence of scabies: a retrospective study of scabies patients in a long-term care hospital. J Dermatol 2011; 38: 874-879. DOI:

Murakonda P, Yazdanbaksh K, Dharmarajan TS. Scabies in the nursing home, misdiagnosis means costs, and embarrassment: story of a centenarian smitten by scabies! J Am Med Dir Assoc 2014; 15: 74-75. DOI:

Bergström FC, Reynolds S, Johnstone M, Pike RN, Buckle AM, Kemp DJ, et al. Scabies mite inactivated serine protease paralogs inhibit the human complement system. J Immunol 2009; 182: 7809-7817. DOI:

Mika A, Reynolds SL, Mohlin FC, Willis C, Swe PM, Pickering DA, et al. Novel scabies mite serpins inhibit the three pathways of the human complement system. PLoS One 2012; 7: e40489. DOI:

Mika A, Reynolds SL, Pickering D, McMillan D, Sriprakash KS, Kemp DJ, Fischer K. Complement inhibitors from scabies mites promote streptococcal growth - a novel mechanism in infected epidermis? PLoS Negl Trop Dis 2012; 6: e1563. DOI:

Swe PM, Fischer K. A scabies mite serpin interferes with complement-mediated neutrophil functions and promotes staphylococcal growth. PLoS Negl Trop Dis 2014; 8: e2928. Erratum in: PLoS Negl Trop Dis. 2014; 8: e3415. DOI:

Swe PM, Christian LD, Lu HC, Sriprakash KS, Fischer K. Complement inhibition by Sarcoptes scabiei protects Streptococcus pyogenes - an in vitro study to unravel the molecular mechanisms behind the poorly understood predilection of S. pyogenes to infect mite-induced skin lesions. PLoS Negl Trop Dis 2017; 11: e0005437. DOI:

Swe PM, Reynolds SL, Fischer K. Parasitic scabies mites and associated bacteria joining forces against host complement defence. Parasite Immunol 2014; 36: 585-593. DOI:

Binić I, Janković A, Jovanović D, Ljubenović M. Crusted (Norwegian) scabies following systemic and topical corticosteroid therapy. J Korean Med Sci 2010; 25: 188-191. DOI:

Marlière V, Roul S, Labrèze C, Taïeb A. Crusted (Norwegian) scabies induced by use of topical corticosteroids and treated successfully with ivermectin. J Pediatr 1999; 135: 122-124. DOI:

Baccouche K, Sellam J, Guegan S, Aractingi S, Berenbaum F. Crusted Norwegian scabies, an opportunistic infection, with tocilizumab in rheumatoid arthritis. Joint Bone Spine 2011; 78: 402-404. DOI:

Melgar E, Liegeon AL, Truchetet F. Développement d'une gale mortelle sous dermocorticoïdes. Presse Med 2017; 46: 335-337. DOI:

Martínez Braga G, Di Martino Ortiz B, Rodríguez Masi M, Bolla De Lezcano L. [Erythrodermic crusted scabies induced by corticosteroids treated with ivermectin. A case report]. Rev Espanola Geriatr Gerontol 2011; 46: 174-175 (in Spanish). DOI:

Jaramillo-Ayerbe F, Berrío-Muñoz J. Ivermectin for crusted Norwegian scabies induced by use of topical steroids. Arch Dermatol 1998; 134: 143-145. DOI:

Walton SF, Beroukas D, Roberts-Thomson P, Currie BJ. New insights into disease pathogenesis in crusted (Norwegian) scabies: the skin immune response in crusted scabies. Br J Dermatol 2008; 158: 1247-1255. DOI:

Millard LG. Norwegian scabies developing during treatment with fluorinated steroid therapy. Acta Derm Venereol 1977; 57: 86-88.

Lipitz R, Tur E, Brenner S, Krakowski A. Norwegian scabies following topical corticosteroid therapy. Isr J Med Sci 1981; 17: 1165-1168.

Clayton R, Farrow S. Norwegian scabies following topical steroid therapy. Postgrad Med J 1975; 51: 657-659. DOI:

Mounsey K, Ho MF, Kelly A, Willis C, Pasay C, Kemp DJ, et al. A tractable experimental model for study of human and animal scabies. PLoS Negl Trop Dis 2010; 4: e756. DOI:

Mounsey KE, Murray HC, Bielefeldt-Ohmann H, Pasay C, Holt DC, Currie BJ, et al. Prospective study in a porcine model of Sarcoptes scabiei indicates the association of Th2 and Th17 pathways with the clinical severity of scabies. PLoS Negl Trop Dis 2015; 9: e0003498. DOI:

Johnston G, Sladden M. Scabies: diagnosis and treatment. BMJ 2005; 331: 619-622. DOI:

Banerji A. Canadian Paediatric Society, First Nations, Inuit and Métis Health Committee. Scabies. Paediatr Child Health 2015; 20: 395-402. DOI:

Stamm LV, Strowd LC. Ignoring the "Itch": the global health problem of scabies. Am J Trop Med Hyg 2017; 97: 1647-1649. DOI:

Walton SF, Currie BJ. Problems in diagnosing scabies, a global disease in human and animal populations. Clin Microbiol Rev 2007; 20: 268-279. DOI:

Jannic A, Bernigaud C, Brenaut E, Chosidow O. Scabies itch. Dermatol Clin 2018; 36: 301-308. DOI:

Nishihara K, Shiraishi K, Sayama K. Leukocytoclastic vasculitis associated with crusted scabies. Eur J Dermatol 2018; 28: 242-243. DOI:

Hay RJ. Norwegian scabies in a patient with a cutaneous vasculitis. Guys Hosp Rep 1974; 123: 177-185.

Fremont G, Benamor S, Gaulier A, Sigal Grinberg M, Petit A. Eruption prurigineuse et purpurique. Ann Dermatol Venereol 2003; 130: 61-62.

Valks R, Buezo GF, Daudén E. Scabies and leukocytoclastic vasculitis in an HIV-seropositive man. Int J Dermatol 1996; 35: 605-606. DOI:

Jarrett P, Snow J. Scabies presenting as a necrotizing vasculitis in the presence of lupus anticoagulant. Br J Dermatol 1998; 139: 701-703. DOI:

Menné T, Christophersen J, Gram N, Bjerrehus T. Scabietic leucocytoclastic vasculitis with focal glomerulonephritis. Acta Derm Venereol 1984; 64: 445-447.

Clevy C, Brajon D, Combes E, Benzaquen M, Dales JP, Koeppel MC, Berbis P. Vasculite scabieuse: 2 cas. Ann Dermatol Venereol 2017; 144: 349-355. DOI:

Estève E, Maitre F, Legac E. Purpura vasculaire au cours d'une gale sévère. Ann Dermatol Venereol 2001; 128: 911-914.

Chung S-D, Lin H-C, Wang K-H. Increased risk of pemphigoid following scabies: a population-based matched-cohort study. J Eur Acad Dermatol Venereol 2014; 28: 558-564. DOI:

Ostlere LS, Harris D, Rustin MH. Scabies associated with a bullous pemphigoid-like eruption. Br J Dermatol 1993; 128: 217-219. DOI:

Currie B, Huffain S, O'Brien D, Walton S. Ivermectin for scabies. Lancet 1997; 350: 1551. DOI:

Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5: 685-694. DOI:

Lynar S, Currie BJ, Baird R. Scabies and mortality. Lancet Infect Dis 2017; 17: 1234. DOI:

Scott GR, Chosidow O, IUSTI/WHO. European guideline for the management of scabies, 2010. Int J STD AIDS 2011; 22: 301-303. DOI:

Salavastru CM, Chosidow O, Boffa MJ, Janier M, Tiplica GS. European guideline for the management of scabies. J Eur Acad Dermatol Venereol 2017; 31: 1248-1253. DOI:

Currie BJ, McCarthy JS. Permethrin and ivermectin for scabies. N Engl J Med 2010; 362: 717-725. DOI:

Nofal A. Variable response of crusted scabies to oral ivermectin: report on eight Egyptian patients. J Eur Acad Dermatol Venereol 2009; 23: 793-797. DOI:

Dia D, Dieng MT, Ndiaye AM, Ndiaye B, Develoux M. La gale croûteuse (norvégienne) à Dakar (Sénégal). Dakar Med 1999; 44: 243-245.

Rosumeck S, Nast A, Dressler C. Ivermectin and permethrin for treating scabies. Cochrane Database Syst Rev 2018; 4: CD012994. DOI:

Mounsey KE, Bernigaud C, Chosidow O, McCarthy JS. Prospects for moxidectin as a new oral treatment for human scabies. PLoS Negl Trop Dis.2016; 10: e0004389. DOI:

Bernigaud C, Fang F, Fischer K, Lespine A, Aho LS, Dreau D, et al. Preclinical study of single-dose moxidectin, a new oral treatment for scabies: efficacy, safety, and pharmacokinetics compared to two-dose ivermectin in a porcine model. PLoS Negl Trop Dis 2016; 10: e0005030. DOI:

Bernigaud C, Fang F, Fischer K, Lespine A, Aho LS, Mullins AJ, et al J. Efficacy and pharmacokinetics evaluation of a single oral dose of afoxolaner against sarcoptes scabiei in the porcine scabies model for human infestation. Antimicrob Agents Chemother 2018; 62: e02334-17. DOI:

Efficacy study between two different dosages of an antiparasitic in patients with crusted scabies - [first cited 2016 July 22; last update 2020 November 23]. Available from:

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How to Cite

Skayem, C., Majda, A., Gary, C., Hemery, F., Mahé, E., Caux, F., Dupin, N., Senet, P., Greder-Belan, A., Hillion, B., Meni, C., Saiag, P., Bellaud, G., Bleibtreu, A., Lariven, S., Bollens, D., Descamps, V., Molina, J.-M., Bouchaud, O., Vittecoq, D., Do-Pham, G., Foulet, F., Botterel, F., Chosidow, O., & Bernigaud, C. (2023). Severe Scabies: A French Multi-centre Study Involving 95 Patients with Crusted and Profuse Disease and Review of the Literature. Acta Dermato-Venereologica, 103, adv00878.

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