We report a case of a 71-year-old man infected at a
nursing home who developed a
bullous pemphigoid-like eruption with nail involvement. He was diagnosed by his family doctor as suffering from
eczema and was treated with topical
corticosteroids, then
blisters started appearing. He was next diagnosed as suffering from
bullous pemphigoid and treated with oral
prednisolone, which worsened his condition. He was finally diagnosed as having crusted
scabies with
bullous pemphigoid-like eruptions and nail involvement at our clinic. He was then prescribed oral
ivermectin (two doses of 12 mg
ivermectin with a 1-week interval) and topical
lindane (1%gamma-BHC in
petrolatum) for
scabies with 5%
salicylic acid in
plastibase as an additional treatment for the crusted lesions on his soles. He showed remarkable improvement in 2 weeks, and his nails showed complete recovery after 7 weeks of
occlusive dressing treatment with 1%gamma-BHC. One and a half years later, the patient showed no sign of a recurrence of
scabies. The histology of a
blister taken from this patient was similar to that of
bullous pemphigoid. Direct immunofluorescence showed
immunoglobulin (Ig)G and C3 deposition at the dermoepidermal junction similar to that of
bullous pemphigoid, but indirect immunofluorescence was negative. The bullous symptoms of this patient were considered to be due to the
scabies, because the patient recovered completely after receiving treatment for
scabies. Indirect immunofluorescent study is important to distinguish between
scabies with
blister formation and true
bullous pemphigoid.