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Images in Paediatrics
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Available online 10 July 2025
Nodular scabies
Escabiosis nodular
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Rubén Casados-Vergaraa, Julio C. Salas-Alanísb, Mauricio Salas-Garzaa, María G. Moreno-Treviñoc,d, Gerardo Rivera-Silvac,d,
a Fundación Debra México, Monterrey, NL, Mexico
b Preparatoria No. 15, Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
c Banco de Tejidos Cardiovascular, Escuela de Medicina, Universidad de Monterrey, Monterrey, NL, Mexico
d Departamento Académico, Escuela de Medicina, Universidad de Monterrey, Monterrey, NL, Mexico
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Received 30 April 2025. Accepted 30 May 2025
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An 8-month-old infant presented with a 30-day history of intensely pruritic nodules on the right axilla, chest and abdomen. His parents also reported the recent onset of itching, particularly at night. Despite various topical treatments, the lesions persisted. On examination, the child had excoriated, erythematous papular and nodular lesions (Fig. 1 and video). Laboratory tests revealed leukocytosis with eosinophilia. Although a biopsy was declined, clinical findings supported a diagnosis of nodular scabies. Initial treatment with 5% permethrin lotion was applied overnight and repeated after one week but was discontinued due to irritation. As nodules remained, a 6% sulfur ointment was applied in two cycles. After eight weeks, topical steroids were introduced for post-scabietic nodules, along with a two-week course of 0.1% topical tacrolimus, with good results.

Figure 1.

General appearance of the patient’s papulonodular lesions.

Nodular scabies is a chronic and less common variant of scabies, characterized by persistent, itchy, reddish-brown nodules. It primarily affects individuals in overcrowded or low-income areas.1 Biopsy and laboratory tests are not required for diagnosis, although dermoscopy or the Müller test can help detect mites or burrows. Other insect bites should be ruled out.2 Treatment typically involves permethrin, and alternative therapies such as topical steroids and tacrolimus are effective for managing post-scabietic nodules.3

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References
[1]
D. Ramachandra Reddy, P. Ramachandra Reddy.
Nodular scabies: a classical case report in an adolescent boy.
J Parasit Dis., 39 (2015), pp. 581-583
[2]
A. Grau-Echevarría, C. Labrandero-Hoyos, R. Peñuelas-Leal, A. Pérez-Ferriols.
Nodular scabies mimicking insect bites.
Infection., 51 (2023), pp. 1869-1870
[3]
A.K.C. Leung, J.M. Lam, K.F. Leong.
Scabies: a neglected global disease.
Curr Pediatr Rev., 16 (2020), pp. 33-42
Copyright © 2025. Asociación Española de Pediatría
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