Doctors suspect that nearly two years of applying traditional herbal remedies to manage rheumatoid arthritis left this young woman with severe crusted scabies.

The patient, aged in her 20s, was unable to afford medication or travel costs, so sought care from a traditional herbal healer in rural Myanmar.

She was given a regimen of unlabelled creams, drinks and tablets, reportedly derived from botanical preparations.

The remedies improved her joint pain, swelling and stiffness, although she was left with residual symmetrical swan-neck deformities and fixed-joint changes from chronic inflammatory arthritis.