Volume 95, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Scabies is a common contagious cutaneous disease and usually affects the young, characterized by polymorphous lesions that may present as burrows, pruritic papules, and inflammatory nodules. Bullous scabies (BS) is its rather rare subtype, mimicking bullous pemphigoid. We report a 15-year-old Chinese boy presenting with 1-month history of pruritic bullae on his penile skin, showing poor response to both topical steroids and systemic antihistamines, but cured by sulfur ointment alone. No recurrence occurred in the 5 years of follow-up. We also reviewed the published cases. Up to date, 44 cases, including the present, have been reported. Of them, 30 were male and 14 were female. The age range was from 1 to 89 years old, with a median age of 70.6 years. The bullous lesions may involve the arms, legs, trunk, genitals, feet, buttocks, thighs, neck, inguinal folds, and may even be generalized. Trunk and extremities are the most common involved locations. Facial or mucosa involvement had never been reported. The histological findings present as a subepidermal split with variable inflammatory infiltrate predominantly neutrophils, and eosinophilic spongiosis, or both. Eighteen of 32 patients showed positive deposition of linear-granular IgG or complement 3 alone or in various combinations, and five of 24 patients revealed circulating IgG. All the 40 cases with therapeutic details were cured by antiscabietic remedy. BS always involves the trunk and extremities. It has a predilection for elderlies and males. The treatments for BS are similar to those of classical scabies.


Article metrics loading...

Loading full text...

Full text loading...



  1. Orkin M, , 1995. Scabies: what is new? Curr Probl Dermatol 22: 105111.[Crossref]
  2. Karthikeyan K, , 2007. Scabies in children. Arch Dis Child Educ Pract Ed 92: e65e69.[Crossref]
  3. Hengge UR, Currie BJ, Jäger G, Lupi O, Schwartz RA, , 2006. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis 6: 769779.[Crossref]
  4. Hicks MI, Elston DM, , 2009. Scabies. Dermatol Ther (Heidelb) 22: 279292.[Crossref]
  5. Heukelbach J, Freldmeier H, , 2006. Scabies. Lancet 367: 17671774.[Crossref]
  6. Sunderkötter C, Mayser P, Fölster-Holst R, Maier WA, Kampen H, Hamm H, , 2007. Scabies. J Dtsch Dermatol Ges 5: 424430.[Crossref]
  7. Chosidow O, , 2000. Scabies and pediculosis. Lancet 355: 819826.[Crossref]
  8. Wendel K, Rompalo A, , 2002. Scabies and pediculosis pubis: an update of treatment regimens and general review. Clin Infect Dis 35: S146S151.[Crossref]
  9. Estes SA, , 1982. The diagnosis and management of scabies. Med Clin North Am 66: 955963.[Crossref]
  10. Witkowski JA, Parish LC, , 1984. Scabies: a cause of generalized urticaria. Cutis 33: 277279.
  11. Rudolph RI, , 1982. Scabies resembling Darier's disease. JAMA 247: 1937.[Crossref]
  12. Ackerman AB, Stewart R, Stillman M, , 1975. Scabies masquerading as dermatitis herpetiformis. JAMA 233: 5354.[Crossref]
  13. Bean SF, , 1974. Bullous scabies. JAMA 230: 878.[Crossref]
  14. Gutte RM, , 2013. Bullous scabies in an adult: a case report with review of literature. Indian Dermatol Online J 4: 311313.[Crossref]
  15. Bhawan J, Milstone E, Malhotra R, Rosenfeld T, Appel M, , 1991. Scabies presenting as bullous pemphigoid-like eruption. J Am Acad Dermatol 24: 179181.[Crossref]
  16. Rossell LG, Redonnet MS, Millet PU, , 2010. Bullous scabies responding to ivermectin therapy. Actas Dermosifiliogr 101: 8184.[Crossref]
  17. Shahab RK, Loo DS, , 2003. Bullous scabies. J Am Acad Dermatol 49: 346350.[Crossref]
  18. Ansarin H, Jalali MH, Mazloomi S, Soltani-Arabshahi R, Setarehshenas R, , 2006. Scabies presenting with bullous pemphigoid-like lesions. Dermatol Online J 12: 19.
  19. Kaur S, Thami GP, , 2003. Bullous scabies in an adult. Clin Exp Dermatol 28: 9394.[Crossref]
  20. Veraldi S, Scarabelli G, Zerboni R, Pelosi A, Gianotti R, , 1996. Bullous scabies. Acta Derm Venereol 76: 167168.
  21. Nakamura E, Taniguchi H, Ohtaki N, , 2006. A case of crusted scabies with a bullous pemphigoid-like eruption and nail involvement. J Dermatol 33: 196201.[Crossref]
  22. Jena DK, Dash ML, Chhetia R, , 2005. Bullous scabies in a patient on anticancer therapy. Indian J Dermatol Venereol Leprol 71: 5354.[Crossref]
  23. Viraben R, Dupre A, , 1989. Scabies mimicking bullous pemphigoid. J Am Acad Dermatol 20: 134136.[Crossref]
  24. Ostlere LS, Harris D, Rustin MH, , 1993. Scabies associated with a bullous pemphigoid-like eruption. Br J Dermatol 128: 217219.[Crossref]
  25. Parodi A, Saino M, Rebora A, , 1993. Bullous pemphigoid-like scabies. Clin Exp Dermatol 18: 293.[Crossref]
  26. Said S, Jay S, Kang J, Liem WH, Jensen JL, Jeffes EWB, III, 1993. Localized bullous scabies: uncommon presentation of scabies. Am J Dermatopathol 15: 590593.[Crossref]
  27. Haustein UF, , 1995. Bullous scabies. Dermatology 190: 8384.[Crossref]
  28. Slawsky LD, Maroon M, Tyler WB, Miller OF, , 1996. Association of scabies with a bullous pemphigoid-like eruption. J Am Acad Dermatol 34: 878879.[Crossref]
  29. Bosch-García R, Arce Calvo MF, Gallardo-Pérez MA, Ruiz del Portal Pérez-Bryan G, Herrera Ceballos E, , 2000. Sarna ampollosa: a propósito de dos casos. Actas Dermosifiliogr 91: 219222.
  30. Bornhovd E, Partscht K, Flaig MJ, Messer G, , 2001. Bullous scabies and scabies-triggered bullous pemphigoid. Hautarzt 52: 5661.[Crossref]
  31. Serra D, Pedro Reis J, Mariano A, Machado A, Figueiredo A, , 2010. Recurrent bullous scabies. J Cutan Med Surg 14: 175177.[Crossref]
  32. Wozniacka A, Hawro T, Schwartz RA, , 2008. Bullous scabies: a diagnostic challenge. Cutis 82: 350352.
  33. Marciniak A, Czarnecka-Operacz M, Silny W, Zaba R, Bowszyc-Dmochowska M, , 2009. Bullous scabies: a case report. Postepy Dermatol Alergol 26: 161164.
  34. Roxana Stan T, Piaserico S, Bordignon M, Salmaso R, Zattra E, Alaibac M, , 2011. Bullous scabies simulating pemphigoid. J Cutan Med Surg 15: 5557.[Crossref]
  35. Chen MC, Luo DQ, , 2014. Bullous scabies failing to respond to glucocorticoids, immunoglobulin, and cyclophosphamide. Int J Dermatol 53: e265e266.[Crossref]
  36. Balighi K, Robati RM, Hejazi N, , 2006. A dilemma: bullous pemphigoid-like eruption in scabies or scabies-induced bullous pemphigoid. Dermatol Online J 12: 13.
  37. Zhang M, Liao WJ, Li CX, , 2014. A case of bullous scabies [in Chinese]. J Clin Dermatol 43: 484486.
  38. Huang MX, Li ZS, Luo DQ, Lin Q, , 2015. Bullous pemphigoid-like eruption subsequent to scabies: bullous scabies or bullous pemphigoid? G Ital Dermatol Venereol 150: 337339.
  39. Maan MA, Maan MS, Sohail AM, Arif M, , 2015. Bullous scabies: a case report and review of the literature. BMC Res Notes 8: 254.[Crossref]
  40. Akin Belli A, Geyik N, Dervis E, , 2015. A case of bullous scabies misdiagnosed as acquired epidermolysis bullosa. Int J Dermatol 54: e499e501.[Crossref]
  41. Su WJ, Fang S, Chen AJ, Shan K, , 2015. A case of crusted scabies combined with bullous scabies. Exp Ther Med 10: 15331535.
  42. Shirlene-Jay SS, Kang J, Liem WH, Jensen JL, Jeffes EWB, , 1993. Localized bullous scabies. Am J Dermatol 15: 590593.[Crossref]
  43. Kambara T, Takeuchi M, Takahashi I, Takekawa M, Sugita Y, Ishii N, Nakajima H, , 1999. A case of crusted scabies associated with bullous pemphigoid. Hifu 41: 209213.
  44. Inoue T, Nomoto M, Arase S, , 2000. A case of Norwegian scabies associated with bullous pemphigoid. Hifu Rinsho 42: 11651168.
  45. Brar BK, Pall A, Gupta RR, , 2003. Bullous scabies mimicking bullous pemphigoid. J Dermatol 30: 694696.[Crossref]
  46. Clyti E, Beylot-Barry M, Demay O, , 1997. Bullous scabies: a sometimes difficult diagnosis. Nouv Dermatol 16: 218219.
  47. Galvany Rossell L, Salleras Redonnet M, Umbert Millet P, , 2010. Bullous scabies responding to ivermectin therapy. Actas Dermosifiliogr 101: 8184.[Crossref]
  48. Ezaki C, Hasegawa K, Kiyoshima M, Mori T, , 1994. Crusted scabies with bullous pemphigoid. Rinsho Hifuka 48: 779782.
  49. Kurosawa M, Yamamoto S, Higashi K, Ookido M, , 1992. Crusted scabies with bullous eruption (in Japanese). Hifu Rinsho 34: 18831886.
  50. Ponce-Navarez E, Przybilla B, , 1981. Bullous scabies in hereditary dystrophic epidermolysis bullosa. Hautarzt 32: 9697.
  51. Konishi N, Suzuki K, Tokura Y, Hashimoto T, Takigawa M, , 2000. Bullous eruption associated with scabies: evidence for scabetic induction of true bullous pemphigoid. Acta Derm Venereol 80: 281283.[Crossref]
  52. Chung SD, Lin HC, Wang KH, , 2014. Increased risk of pemphigoid following scabies: a population-based matched-cohort study. J Eur Acad Dermatol Venereol 28: 558564.[Crossref]
  53. Wang CH, Lee SC, Huang SS, Kao YC, See LC, Yang SH, , 2012. Risk factors for scabies in Taiwan. J Microbiol Immunol Infect 45: 276280.[Crossref]
  54. Miller DD, Bhawan J, , 2013. Bullous tinea pedis with direct immunofluorescence positivity: when is a positive result not autoimmune bullous disease? Am J Dermatopathol 35: 587594.[Crossref]
  55. Mir F, Cruz-Oliver DM, , 2014. Scabies manifesting as bullous pemphigus in a nursing home resident. J Am Geriatr Soc 62: 12011203.[Crossref]

Data & Media loading...

  • Received : 07 Apr 2016
  • Accepted : 18 May 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error