This case report presents a classical case of nodular
scabies in a 12 year boy who complained of
itching for 20-21 days before presentation to the hospital. Application of
Betnovate ointment (
Betamethasone valerate 0.1 %) before presentation to the hospital had provided only 2-3 days of relief from
itching. Dermatological examination revealed skin colored to erythematous papule of 3-4 mm on the body with predilection for web space of fingers and flexural areas and nodules on the scrotum and groin. Based on this, clinical diagnosis of
scabies with nodular
scabies was made on the child. The scraping obtained from the web-space of the child showed mite under the light microscope, which confirms the diagnosis. Treatment with topical
permethrin 5 % lotion resulted in 50-70 % subsidence of
itching within a day, and improvement in
impetigo lesions of his father in 5 days. However, the scrotal and groin nodular lesion of the child persisted with severe
itching. Treatment with topical
steroid and
tacrolimus 0.1 %
ointment did not show much improvement.
Intralesional injection of
triamcinolone (5 mg/ml) on the nodule resulted in 30-40 % subsidence in
itching and 50-60 % reduction in the size of the lesion over 2-3 weeks.