Bullous scabies in an adult: A case report with review of literature
A 26-year-old unmarried male presented with a four-day history of multiple blisters over both hands preceded by a two-week history of generalized pruritus. The patient was living alone. He also complained of itchy red raised lesions over the genitals. The itching was more during night. The patient denied any history of unprotected sexual exposure.\nExamination revealed multiple, erythematous excoriated papules on the wrist, trunk, lower limbs, and web spaces of fingers. Multiple erythematous papulonodular lesions were seen over the scrotum and penis. Multiple tense vesicles and bullae, 0.5-1.5 cm sized, containing clear fluid were also present on the dorsum of both hands and web spaces of fingers []. There were no mucosal lesions. Other cutaneous and systemic examination was unremarkable. A diagnosis of bullous scabies was considered.\nBiopsy and histopathology of one of the vesicles revealed epidermal spongiosis, multilocular intraepidermal blisters, subepidermal edema with dense lymphohistiocytic infiltrate, and a few eosinophils. The blister cavity also contained inflammatory cells with eosinophils being predominant. The presence of mites within the blister cavity was also noted []. Based on clinicopathological correlation, a diagnosis of bullous scabies was made.\nImmunofluroscence study could not be done due to economic constraints. The patient was treated with whole-body applications of 5% permethrin lotion and a single 12 mg dose of oral ivermectin along with oral antihistamines to control pruritus. New lesions stopped appearing and after one week, significant improvement was noted. Skin lesions cleared after one month.