Clinical presentation

In patients with HIV infection, both the classic form and crusted Norwegian scabies (named because of its initial description in Norwegian patients with leprosy) can occur. The classic  form can occur at  any  CD4  cell  count,  while  Norwegian  scabies is  usually  seen  in  patients  with  a  CD4  cell  count  below 150 cells/μL.(^[112]  Classic scabies presents as papulovesicular lesions. The distribution varies, favouring the wrists, interdigital web spaces, elbows, axillae, breasts and genitals. Predominantly night-time pruritus is usually seen. Due to the associated pruritus, excoriation of the lesions often occurs. Bacterial superinfection may occur with impetigo, cellulitis and, in some cases, fatal sepsis. In patients with neurological disorders or immunosuppression, the number of mites can increase unchecked due to the impaired immunity, absence of pruritus or the patient’s physical inability to scratch. Clinically, the eruption is suspected when there is marked thickening, often psoriasiform plaques, papules and crusting of the skin. It occurs primarily on the hands, although the entire body including the face and scalp is often involved.^[113]