A 61-year-old man with rheumatoid arthritis (on high-dose corticosteroids) and a recent hip fracture presents from his nursing home with a rash. He was living independently until 6 weeks ago, when he fell and fractured his hip and has been in a nursing home since then during a prolonged period of post-operative immobility. About 3 weeks earlier, he had a pruritic rash on his wrists and fingers. One week ago, he began developing a thick, crusting rash on his chest, back, and abdomen. Examination in the clinic is notable for a crusted, scaling rash; a diagnosis of crusted scabies is strongly suspected.
Which one of the following is most often identified as a contributor to the development of crusted scabies?

Figure 1. Crusted Scabies in Genital Region
This 71-year-old man with cirrhosis developed an erythematous and scaly rash with marked hyperkeratosis. Microscopic examination showed abundant mites.
Source: Elosua-González M, García-Zamora E. Crusted scabies. N Engl J Med 2017;377:476.
Reproduced with permission. Massachusetts Medical Society. ©2017.
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Question Last Updated
March 13th, 2025
March 13th, 2025
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