Neonatal Norwegian scabies: three cooperating causes

Background: Norwegian or crusted scabies is seldom reported in infancy, usually in immune deficient patients. Main observations: We report a case of an infant affected by atopic dermatitis since birth. The patient was ineffectively treated with topical and systemic steroids for several weeks for the insurgence of cutaneous xerosis and erithema. Clinical inspection and optical microscopic examination of skin scraped scales leaded to the diagnosis of crusted scabies. The physiological inability to scrapping reaction, the immunological profile deriving from atopy and finally iatrogenic immunodepression cooperating to conduce to crusted scabies. Conclusion: In our case iatrogenic immunosuppression, atopic dermatitis and the absence of skin scraping reaction because of the very young age might have contributed to the unusual presentation of scabies. This case suggests considering possible alternative diagnosis of scabies in the failure of the treatment for atopic eczema.