Management of Scabies in Patients With Human Immunodeficiency Virus Disease

To the Editor.— A retrospective review of selected human immunodeficiency virus (HIV)-infected patients with scabies seen in our clinics between December 1990 and March 1992 revealed several clinical patterns with respect to morphologic findings and response to treatment. The Table lists representative cases with atypical clinical morphologic patterns ortreatment responses. These patterns tended to correlate with helper T-cell count and the stage of HIV disease. Patients with CD4 counts above 1.5×109/L had normal clinical morphologic patterns. Atypical morphologic patterns were restricted to patients with CD4 counts less than 1.5×109/L. These included the following two different morphologic patterns: Papular scabies is defined as a diffuse uniform eruption of 5- to 7-mm papules, each topped with a scabietic burrow. Each lesion is erythematous and inflamed, but a diffuse hypersensitivity rash is not a component. There may be associated pruritus, sometimes severe. Norwegian scabies is defined as a generalized psoriasiform scaling and hyperkeratotic eruption. Thick, crusted plaques may be seen on the scalp, face, hands, buttocks, genitalia, and pressure-bearing areas. Pruritus may be slight to nonexistent.