Dermatology: Practical and Conceptual


Research Letter | Dermatol Pract Concept. 2023;13(2):e2023079 1

Crusted Scabies of Hands: Constraints of 
Teledermatology

Sümeyre Seda Ertekin1, Ayşenur Botsalı2, Senem Danacı3, Seçil Vural1

1 Department of Dermatology and Venereology, Koç University School of Medicine, İstanbul, Turkey
2 University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey

3 Koç University School of Medicine, İstanbul, Turkey

Key words: crusted scabies, teledermatology, contact dermatitis, corticosteroids, COVID19

Citation: Ertekin SS, Botsalı A, Danacı S, Vural S. Crusted Scabies of Hands: Constraints of Teledermatology. Dermatol Pract Concept. 
2023;13(2):e2023079. DOI: https://doi.org/10.5826/dpc.1302a79

Accepted: June 20, 2022; Published: April 2023

Copyright: ©2023 Ertekin 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: Secil Vural, MD, Department of Dermatology, Koç University School of Medicine. Telephone: +905054324682 
E-mail: sevural@ku.edu.tr

Introduction

During the COVID-19 pandemic, teledermatology has 

emerged as an accurate and cost-effective alternative for 

conventional face-to-face dermatological consultations [1]. 

During the pandemic period, we observed 2 cases of crusted 

scabies induced by prolonged topical potent corticoste-

roid use.

Case Report

Two healthy male (aged 18 and 19 years, respectively) pa-

tients were diagnosed with hand irritant contact dermatitis 

caused by frequent hand-washing and sanitizer use with 

teledermatology. They received topical betamethasone cream 

treatment initially. The physicians escalated the treatment to 

clobetasol cream occlusion therapy via another telederma-

tology appointment as the symptoms did not improve.

The patients used this therapy continuously without 

any follow-up appointments for one and two months and 

presented to our clinic with worsening of pruritus on hands. 

Face-to-face physical examination revealed hyperkeratotic 

and fissured plaques on the dorsum of hands, prominently 

around the proximal phalanges, whereas the palmar sides of 

the hands were relatively spared. Dermoscopic examination 

revealed numerous furrows and delta-wing jet signs corre-

sponding to the mites (Figure 1). The patients were diag-

nosed with crusted scabies and treated with oral ivermectin 

and topical 5% sulfur ointment. The consent is taken from 

each patient to publish their photos and treatment.

Conclusions

Physicians and patients report high satisfaction using teleder-

matology, and it has a promising future in daily clinical prac-

tice [2]. However, there are some concerns regarding the 

diagnostic accuracy of teledermatology services. Poor image 

quality and the inability of evaluating textural characteris-

tics of lesions may confuse a dermatologist. Here, the lack 

of dermoscopic examination and the inability to perform 



2 Research Letter | Dermatol Pract Concept. 2023;13(2):e2023079

a detailed full-body examination may have mislead the cli-

nicians. In teledermatology, if the patient is not improving 

with the prescribed treatment, he/she should be invited for 

the in-person visits to avoid any delay in the diagnosis.

References

1. Elsner P. Teledermatology in the times of COVID-19 - a system-

atic review. J Dtsch Dermatol Ges. 2020;18(8):841-845. DOI: 

10.1111/ddg.14180. PMID: 33448667.

2. Yeroushalmi S, Millan SH, Nelson K, Sparks A, Friedman AJ. 

Patient Perceptions and Satisfaction With Teledermatology 

During the COVID-19 Pandemic: A Survey-Based Study. J Drugs 

 Dermatol. 2021;20(2):178-183. DOI: 10.36849/JDD.5714. 

PMID: 33538563.

Figure 1. Clinical and dermatoscopic findings. (A-B) Hyperkeratotic 

and fissured plaques on the dorsum of the hands in Case 1, with rela-

tively spared palmar side, (C) Thick, hyperkeratotic plaques, erythem-

atous papules on the dorsum of hands of Case 2, (D-E) Numerous 

furrows filled with dark-brown triangular structures (delta-wing jet 

sign with contrail) corresponding to the mites on the dermatoscopic 

examination of Case 1.