Scrape to Nail the Diagnosis: A “Mitey” Challenge in an Erythroderma

Norwegian (crusted) scabies is a highly contagious form of scabies which can evolve into erythroderma at times. We herein report a case of a 29-year-old male patient, an established case of epidermolysis bullosa dystrophica (EBD), presented to us with asymptomatic generalized scaling and crusting of 2 months duration. On examination patient also had dystrophic nails, anonychia and joint contractures. With a high index of suspicion, a scraping for KOH mount had done, which showed numerous scabies mites, eggs and faecal pellets. The patient was started on weekly oral Ivermectin (200mcg/kg) and topical 5% permethrin application. There was dramatic response within 1-2 weeks. This case is presented to highlight the diagnostic challenge that erythroderma may be due to Norwegian scabies or the primary entity- epidermolysis bullosa dystrophica (EBD). The association of EBD and Norwegian scabies has been reported in literature. A simple bedside test like scraping can nail the diagnosis, provided there is a high index of suspicion.