Q:

12/25/2012
38 y/o female suffering with persistent scabies (for one year) as diagnosed by 2 previous dermatologists. She tried multiple treatments of permethrin, ivermectin, and topical oils (tea tree, clove) plus necessary cleaning of home and clothing. She reports her dermatologist said something is wrong with her immune system. She reports multiple chiropractic treatments a couple of years before contracting scabies that "have changed her body structure" including causing foul smelling urine, increased clotting during period and some lower back pain. Blood and urine levels are normal. What further tests can I order or where can I refer her?

A:

Thank you for your inquiry.

I cannot answer your question with any confidence, but I can refer you to an excellent review article on scabies published in the New England Journal of Medicine (1). I also will forward your inquiry to the author of that review, Dr. Olivier Chosidow, to solicit a response. He is an internationally known expert in this disorder.

When I receive a reply from Dr. Chosidow, I will forward it to you.

Thank you again for your inquiry.

Reference:
1. Chosidow O. New England Journal of Medicine 2006; 354:1718-1727.

Sincerely,
Phil Lieberman, M.D.

We received a response to your Ask the Expert inquiry from Dr. Chosidow. Thank you again for your inquiry and we hope this response is helpful to you.
 
Sincerely,
Phil Lieberman, M.D.
 
Response from Dr. Chosidow:
Except very rare cases of crusted scabies, the disease cannot persist as long as it is suggested. I would recommend
- to strongly try to confirm the diagnosis of scabies using dermoscopy and multiple parasitologic scraps
- if the diagnosis is not confirmed which is my opinion, one hypothesis might be post scabies delusional of parasitosis (see recent articles in the Archives of Dermatology and JAAD). I changed my opinion since 2000 (Chosidow O Scabies and pediculosis, Lancet 2000) and I would suggest that a experienced dermatologist/internal medicine prescribed an anti psychotic drug if the diagnosis of delusional of parasitosis is confirmed. I saw some cases and it is very difficult to convince those patients to see a psychiatrist.

Olivier CHOSIDOW, MD, PhD
Prof & Head
Department of Dermatology and UPEC Université Paris-est Créteil Val de Marne

AAAAI - American Academy of Allergy Asthma & Immunology