1 Iconography
Access to the text (HTML) Access to the text (HTML)
PDF Access to the PDF text

Access to the full text of this article requires a subscription.
  • If you are a subscriber, please sign in 'My Account' at the top right of the screen.

  • If you want to subscribe to this journal, see our rates

  • You can purchase this item in Pay Per ViewPay per View - FAQ : 30,00 € Taxes included to order
    Pages Iconography Videos Other
    3 1 0 0

Joint Bone Spine
Volume 78, n° 4
pages 402-404 (juillet 2011)
Doi : 10.1016/j.jbspin.2011.02.008
accepted : 7 February 2011
Crusted Norwegian scabies, an opportunistic infection, with tocilizumab in rheumatoid arthritis

Khadija Baccouche a, Jérémie Sellam a, Sarah Guegan b, Sélim Aractingi b, Francis Berenbaum a,
a Department of Rheumatology, AP–HP, Saint-Antoine Hospital, Pierre-et-Marie-Curie University, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France 
b Department of Dermatology-Allergology, AP–HP, Tenon Hospital, Pierre-et-Marie-Curie University, 1 rue de la Chine, 75020 Paris, France 

Corresponding author. Tel.: +33 1 49 28 25 20; fax: +33 1 49 28 25 13.

Crusted Norwegian scabies is an extremely rare hyperkeratotic variant of scabies infestation. We report herein a case of crusted scabies in a woman with severe rheumatoid arthritis (RA) treated by tocilizumab (TCZ), a monoclonal antibody blocking the interleukin-6 receptor.


An 80-year-old female with severe RA developed erythroderma followed by hyperkeratosis, widespread scaling over the trunk, arms, hands and limbs, and crusted lesions on her scalp. She was on TCZ (8mg/kg per month) with prednisone (20mg/d). Several hypotheses were evoked (i.e., vasculitis, psoriasis or paraneoplasic syndrome) but a microscopic examination of the skin surprisingly demonstrated numerous scabies mites and eggs leading to the diagnosis of crusted (Norwegian) scabies. After repeated use of ivermectin and application of topical piperonyl butoxide cream, scabies disappeared. However, there had been outbreak of scabies among two individuals in the staff and two patients. TCZ was stopped after four infusions because of a severe infectious pneumonia and failure.


Crusted scabies should be evoked in case of pruritus or erythroderma occurring under TCZ therapy and it may be explained by the interleukin-6 blockade.

The full text of this article is available in PDF format.

Keywords : Rheumatoid arthritis, Crusted scabies, Norwegian scabies, Interleukin-6, Tocilizumab

© 2010  Société française de rhumatologie@@#104156@@
EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Article Outline
You can move this window by clicking on the headline