Norwegian scabies in a child with Down syndrome.

Crusty scabies or Norwegian scabies is a highly contagious type of scab that is characterised by intense infestation by Sarcoptes scabiei in the skin and widespread, crusty, hyperkeratotic papules, plaques and nodules. The infection can be missed due to its atypical appearance. Patients with cognitive impairment or an immunodeficiency disorder (including immunosuppressive therapy) are prone to developing crusty scabies. Although the relationship between Down syndrome and crusted scabies is explained as an absence of effective immune system, it is still not fully understood. In this communication we report a 28-month-old girl with Down syndrome who presented with crusted scabies.