A rare variant of crusted scabies

THIS looks like a red scaly rash. Psoriasis, eczema or perhaps a fungal infection might be considered as a cause of all this scale.

The patient had a history of severe atopic eczema and had regularly been treated with oral antibiotics and courses of oral steroids. However, every time her steroids were reduced the rash would flare and her itch would become intolerable. The scale persisted.

The diagnosis was made by asking her partner, who came with her, if anyone else at home was itchy. It turned out that he had an itchy rash. On examination, it showed typical scabies