ISSN: 2320-5407 Int. J. Adv. Res.

11(03), 1011-1014

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/16526
DOI URL: http://dx.doi.org/10.21474/IJAR01/16526

RESEARCH ARTICLE
WHAT AN ITCHYINTERGLUTEALCLEFT CAN HIDE

Soumaya Faras, Ibtissam Boubnane, Meryem Aboudourib, Ouafa Hocar and Said Amal
Dermatology Department, CHU Mohammed VI, Marrakech, Morocco, Bioscience and HealthLaboratory, FMPM
CaddiAyyadUniversity, Marrakech, Morocco.
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Manuscript Info Abstract
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Manuscript History Scabiesis a contagiousubiquitousectoparasitosis, with exclusive human-
Received: 28 January 2023 to-human transmission, It usuallypresentswith herpes, papulo-vesicles,
Final Accepted: 28 February 2023 nodules, and intense pruritus at night, which cause pain and
Published: March 2023 disturbedsleep in the affectedindividuals.Dermoscopy, a non-
invasiveopticalmagnifying technique, has been used to aid in the
diagnosis of scabies in recentyears, as in the case of our patient, aged
57, whopresented an atypicalfeatures of scabies, he was
treatedwithantiycotics and thendermocorticoids, but thanks to
dermoscopy, the diagnosiswasrectified.

Copy Right, IJAR, 2023,. All rights reserved.

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Introduction:-
Scabiesis a contagiousubiquitousectoparasitosis, with exclusive human-to-human transmission, itoccurs as sporadic
cases or smallepidemics, and affects individuals of both sexes, of all ages and from all social backgrounds. In
Morocco, the incidence of scabiesis not wellknown, but itisprobably high. It is a wellknownparasitic infection but it
can bedifficult to diagnose, especially in itslocalizedform, especially in the absence of pruritus in the environment.
We report the case of a 57years old man with a localizedpruriticeczematous rash for more than 6 months, for
whichdermoscopyallowed to rectify the diagnosiswith the identification of grooves and sarcoptes.

Corresponding Author:- Soumaya Faras

Address:- Dermatology Department, CHU Mohammed VI, Marrakech, Morocco, Bioscience
and HealthLaboratory, FMPM CaddiAyyadUniversity, Marrakech, Morocco.

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Clinicalfeatures of the patient withscabies

Observation:-
- A 57years old patient with a history of end-stage renalfailure on haemodialysis,wasadmitted to the clinic for
pruritus on the interglutealcleft, whichhad been present for 6 monthswithoutanyotherassociatedsigns, and had been
seen on several occasions. The eruptionwasinitiallytreated for
bacterialimpetiginisationassociatedwithdermocorticoids, but in view of the worsening of the pruritus and the
extension of the lesion, hewas put on topical antimycotics, but the patient stillhad the extremelypruriticlesion,
whichsignificantlyalteredhisquality of life.
- The interrogation did not mention anymedication or pruritus in the family.
- The clinicalexaminationrevealed a scaly placard taking the interglutealfold and extending to the twobuttocks,
whichwasverypruritic, withscratchinglesions opposite.
- No skin lesionswerefound on the rest of the integument.
- Dermoscopicexaminationshowed the deltaplane signwith the scabiousfurrow.
- The diagnosis of interglutealfoldscabieswas made on the basis of clinical and dermoscopiccriteria and the patient
was put on benzyl benzoate withvery good improvement.
- A few dayslater, ourpatient'swifepresentedwithscabies.

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Dermoscopic image of scabies

Discussion:-
Human scabiesis a well-knownparasitic infection caused by a mite, Sarcoptesscabiei varietyhomini. It iscontagious
and istransmitted in the vastmajority of cases through direct, intimate and prolongedhuman contact.

Sincescabiesis not a notifiabledisease in Morocco [1], itsepidemiology and trueprevalence are unknown. However,
in the experience of healthprofessionals, poverty, overcrowding, bed-sharing and large families are all
factorsthatincrease the risk of scabiesspreading.

The skin lesions are usually not veryspecific but the topographyshouldalert (interdigital spaces, anterior aspect of
wrists, elbows, umbilicus, buttocks, thighs, externalgenitalia, nipples)[2], even in the localized form as in
ourpatient's case, the diagnosis of scabiesshould not beruled out, In general, the diagnosis of scabiesdepends on the
presence of an itchy rash thatworsensduring the night and occurs in characteristic places,
especiallywhenotherfamilymemberspresentwithsymptomsshouldraise the diagnosis and look for the sarcopod. It
isoftenconfusedwithotherpruritic rashes, such as eczema, intertrigo, psoriasis or impetigo [3].

The mite or itseggs can bedemonstratedmicroscopically by scraping a groove with a vaccinostyl. However,
dermoscopy in ourdailypractice has the advantage of being quick and simple, and itisused to confirm the diagnosis
of scabies, whereit shows characteristicsmallbrowntriangular structures or the delta sign [4]. These structures
correspond to the anterior part of the sarcopte (rostrum and two pairs of front legs). The base of the triangle
extendsinto a sinuous groove, the path of the sarcoptes in the stratum corneum, made visible by the presence of air
bubbles and smallbrown-black dots of varying size corresponding to eggs or excreta. Dermoscopy can beused to
avoid or guide the sampling.

Conclusion:-
Scabiesis a verycommonpediculosis, especially in developing countries, and iseasilydiagnosed, but the case
wepresentedisatypical and thanks to dermoscopywewere able to detect the specificsigns of scabies.

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References:-
1. La gale : Anna Banerji MD; Roxanne Goldade MD; James Irvine MD; Radha Jetty MD; Keith Menard MD;
Sam Wong MD [PubMed] [Google Scholar], Paediatr Child Health. 2015 Oct; 20(7): 399–402.
2. Physiopathologie et diagnostic de la gale : Nathalie BARACHY Gilles DREYFUSS
JérémyVONO,Actualitéspharmaceutiques n° 526 mai 2013, Elsevier Masson
3. Localized bullousscabies : uncommonpresentation of scabies : Samireh Said, shirline Jay, Junku Kang, Wieike
H. Liem, Jerald L, Jensen , D.D.S, and Edward W.B. Jeffes, The americanjourna of dermatology 15(6) ; 590-
593. 1993
4. Extensive scabies in nursing home : The usefulness of dermoscopy : N. Kluger, NPG-690; No. of Pages 4,
Elsevier Masson.

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