Scabies with Secondary Impetiginization

A 13-year-old school-going boy presented with a 4-week history of multiple itchy, pus-filled lesions, primarily involving the trunk and groin, with nocturnal exacerbation of itching. On cutaneous examination, discrete, multiple pus-filled vesicles and excoriated papules were observed, predominantly distributed over the groin, involving the penile shaft, scrotal skin, buttocks, and web spaces of the fingers [Figures 1 and 2]. Excoriations and vesicles containing clear fluid were also noted. The lesions had been progressively increasing in number since their onset, with no similar history in family members. Microscopic examination of skin scraping revealed the presence of scabies mites [Figure 3]. On the basis of the above findings, a diagnosis of scabies complicated by secondary impetiginization was made. The patient was treated with overnight application of 5% topical permethrin and oral antibiotics. Simultaneous treatment of family members was advised, recommending the use of topical permethrin once weekly.Figure 1: Multiple discrete pus-filled vesicles and excoriated papules, few rupturing to form superficial erosions with overlying crusts at places involving groinFigure 2: Pus-filled vesicles and excoriated papules, with few rupturing to form overlying crusts involving bilateral buttocksFigure 3: Microscopy examination of skin scrapings showing Sarcoptes scabiei miteScabies, caused by infection with Sarcoptes scabiei, is an important risk factor for impetigo resulting from Streptococcus pyogenes or Group A streptococcus (GAS) and Staphylococcus aureus infection.[1] Inhibition of innate defenses including the complement system is a prerequisite for the successful establishment of bacterial infections. GAS and S. aureus have evolved mechanisms to prevent activation of the complement cascades.[2] Secondary infection in patients with scabies is a rare occurrence manifesting as pustules and pus-filled and clear fluid-filled vesicles in typical distribution, necessitating prompt management and to avoid complications. Declaration of patient consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s)/guardian(s) of the patient. In the form, the parent(s)/guardian(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.