Dermatology: Practical and Conceptual


Dermatology Practical & Conceptual

Image Letter | Dermatol Pract Concept. 2022;12(1):e2022008 1

A Newborn with a Blasckoid-like Distribution Rash: 
Never Forget to Use the Dermoscope

Federica Filippi1, Marco Adriano Chessa1, Federico Bardazzi1, Iria Neri1

1 Dermatology Unit, IRCSS Policlinico di S. Orsola, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 

Bologna, Italy

Citation: Filippi F, Chessa MA, Bardazzi F, Neri I. A newborn with a blasckoid-like distribution rash: never forget to use the dermoscope. 
Dermatol Pract Concept. 2022;12(1):e2022008. DOI: https://doi.org/10.5826/dpc.1201a08

Accepted: April 25, 2021; Published: January 2022

Copyright: ©2022 Filippi et al. This is an open-access article distributed under the terms of the Creative Commons  
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted 
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. 

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Marco Adriano Chessa, MD, Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, 
University of Bologna, Bologna, Italy. E-mail: marco.adriano.chessa@gmail.com

Case Presentation 

A 30-day-old newborn presented with a 7-day history of an 

erythematous-crusted rash with a blasckoid-like distribution 

on his arm and lower limb (Figure 1, A and B). The baby was 

sleeping well, and systemic symptoms were absent. A complete 

blood exam showed no abnormalities except for a mild eosin-

ophilia. Dermoscopy revealed crusted scabies (Figure 1C). 

The patient was treated with permethrin 5% cream, applied 

and left on the skin for 4 hours for 2 consecutive nights and 

then again for 2 consecutive nights after 7 days. Other family 

members were given the same treatment regimen, permethrin 

5% cream, applied and left on the skin for 8 hours. 

Teaching Point

Norwegian or crusted scabies is a variant of scabies with 

a massive infestation of Sarcoptes scabiei. Most cases are 

reported in immunocompromised patients; however, in an 

immature immune system, overcrowded living conditions 

can lead to the appearance of the disease in newborns. 

Our case is peculiar because of the absence of symptoms 

and the papulo-erythematous blasckoid-like presenta-

tion [1]. In these cases, dermoscopy has a central role in 

quickly arriving at a diagnosis and avoiding unnecessary 

 investigation [2].



2 Image Letter | Dermatol Pract Concept. 2022;12(1):e2022008

References

1. Neri I, Chessa MA, Virdi A, Patrizi A. Nodular scabies in in-

fants: dermoscopic examination may avoid a diagnostic pitfall. 

J Eur Acad Dermatol Venereol. 2017;31(12):e530-e531. DOI: 

10.1111/jdv.14401. PMID: 28609546.

2. Engelman D, Yoshizumi J, Hay RJ, et al. The 2020 Interna-

tional Alliance for the Control of Scabies Consensus Criteria 

for the Diagnosis of Scabies. Br J Dermatol. 2020;183(5):808-

820. DOI: 10.1111/bjd.18943. PMID: 32034956. PMCID: 

PMC7687112.

Figure 1. Detail of the erythematous-crusted rash.and. (A) Right lower limb. (B) Left arm with a blasckoid-like distribution. (C) The 

 dermoscopic examination at a magnification of ×10 revealed the clue for diagnosis: typical small brown pigmented triangular structures, 

the so-called hang-glider sign, in addition to S-shaped white burrows or jet-liner sign were detected, leading to the diagnosis of crusted 

scabies.