PPK comprises a group of inherited or acquired disorders characterized by abnormal thickening of the palms and soles. The inherited form results from defects in genes encoding the structural components of keratinocytes, which result in abnormal epidermal thickening.3 The acquired form is associated with various inflammatory or infectious skin conditions, including psoriasis and chronic eczema.
Depending on their pattern of appearance on the palms and soles, clinical lesions of PPK can be categorized into 3 forms: diffuse, focal, and punctate.3 Areas including nonvolar skin, teeth, nails, and sweat glands might also be affected. Treatment includes topical keratolytic agents and topical and oral retinoids.
Treatment and decontamination are needed for Norwegian scabies
Because of the large number of mites in the hyperkeratotic lesions in Norwegian scabies, this disease is difficult to manage.7 The mainstay of therapy is daily application of topical scabicidal agents such as 5% permethrin cream, 1% lindane cream, 6% to 10% sulfur-based topical agents, or 12.5% benzyl benzoate lotion. Although treatment plans are individualized, most of these preparations need to be applied for at least one week.
Application of a mixture of keratolytic agents on the hyperkeratotic areas might help the topical medication gain access to the target areas. Prescribing a single oral dose of ivermectin 200 mcg/kg with a topical preparation is also considered an effective approach to treating Norwegian scabies.4
In light of the highly contagious nature of Norwegian scabies, environmental decontamination is required. Clothes, bedding, and towels should be decontaminated by machine washing them in hot water and drying them in the hot cycle.3 Prophylactic treatment with a topical scabicidal agent may be recommended for an entire institution or visitors and family members in order to prevent endemic outbreaks.
Our patient’s recovery
Our patient was admitted to the intensive care unit and her skin lesions were treated with topical mesulphen once daily for 10 days. The cutaneous lesions improved gradually and the patient returned to the nursing home a month later.
CORRESPONDENCE Wei-Ming Wang, MD, PhD, Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Road, Neihu District, Taipei City 114, Taiwan, R.O.C.; ades0431@ms38.hinet.net