key: cord-1016332-mdy3yml4 authors: Bimbi, César; Wollina, Uwe; Kyriakou, Georgia; Lana, Daiane Flores Dalla; Ramos, Mauro title: Basic teledermatology solving 2 cases of crusted scabies date: 2020-08-21 journal: Dermatol Ther DOI: 10.1111/dth.14214 sha: 78b30003bf0e5f30a777f69a638f7171ef2bda90 doc_id: 1016332 cord_uid: mdy3yml4 nan drafting the manuscript or revising it critically for important intellectual content. Additionally, all authors have given final approval of the version to be published. Each author has participated sufficiently in the work to take public responsibility for appropriate portions of the content and each author has agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The author(s) received no specific funding for this work Data sharing is not applicable to this article as no new data were created or analyzed in this study. Telemedicine has been available for several years, but the pandemic of Coronavirus disease 2019 (COVID-19) has highlighted its importance as an This article is protected by copyright. All rights reserved. immediate, safe, and high standard of care. 1 Dermatology is among the most suited specialties for teleassistance, since its visual nature allows for an expert opinion without the need for an in-person referral. 2 Herein we present two cases of crusted scabies that were successfully diagnosed and treated with the help of teledermatology. Two cohabitant patients with typical scabies were referred to our Department and reported that six other family members had similar complaints after visiting a constrained to bed, elderly relative in a nursing home. At consultation, they showed smartphone pictures of their relative. The photographs had reasonable quality and allowed identification of widespread large hyperkeratotic fissured plaques covered with white-yellowish-silvery scales on the upper limbs and hands ( Figure 1 ). We suggested to one of the relatives to collect skin scrapings in a sterilized urine-sample container with the help of a clean spoon. The specimen was sent to a clinical analysis laboratory where a microscopic potassium hydroxide preparation revealed the presence of large numbers of Sarcoptes ectoparasites ( Figure 2 ). The nursing home personnel was notified and the patient was initiated with oral ivermectin along with topical application of 5% permethrin lotion, resulting in rapid and complete resolution of the lesions (Figure 3 ). This article is protected by copyright. All rights reserved. A medical student living in Europe e-mailed photographs of her 62-year-old mother to one of the authors. The photographs showed an alopecic squamous plaque on the scalp, reported to be intensely pruritic, that persisted for several months despite the application of emollients and topical steroids. The plaque bore fractured hair strands, was eroded by scratching, and covered with crusts ( Figure 4) . The daughter decided to contact us after identifying a paper on crusted scabies published by one of the authors 3 with pictures similar to her mother's. The diagnosis of crusted scabies was considered. Due to lack of access to a local doctor or laboratory, empiric treatment with oral ivermectin and topical 5% permethrin lotion was started and resulted in resolution of the pruritus and significant clinical improvement ( Figure 5 ). Crusted scabies is a rare form of scabies, caused by Sarcoptes scabiei. It occurs in patients with impaired immunologic function such as on the basis of malignancies, autoimmune diseases, and neurologic disorders. In institutional settings, scabies is a significant source of morbidity for both residents and health care workers. [4] [5] Age, reduced mobility, and residency in a nursing home were considered the major risk factors in our patients. This article is protected by copyright. All rights reserved. The objective of this presentation is to highlight the importance of teledermatology as an effective tool for diagnosing dermatological ailments. The initial disbelief about the quality of care and the possible negative impact on the patient-health provider relationship has been confronted by medical literature. [6] [7] [8] The COVID-19 pandemic recognizably was a major stimulus to implement teledermatology in many countries. 1, 9 Platforms were promptly available and, even, legislation and reimbursement systems were rapidly put into place. The care we provided was given using basic and inexpensive technology of cryptographed stored-and-forwarded images, that is available even in resource restrained settings. The interesting characteristic that our cases bring to light is the inverse path taken in order to obtain telecare. Instead of searching for a distant health service, both patients obtained care departing from a visit of relatives (first patient) and a relevant literature research (second patient). We strongly believe that the availability of open access to this kind of care will offer solutions for a myriad of painful health problems. Patients deserve optimum access to it. This article is protected by copyright. All rights reserved. Teledermatology in the wake of COVID-19: Advantages and challenges to continued care in a time of disarray Practice Guidelines for Teledermatology Crusted (Norwegian) scabies as a strong marker of adult T-cell leukemia/lymphoma in HTLV-1 infection A Review of Scabies: An Infestation More than Skin Deep crusted (Norwegian) scabies and the diagnosis of mite sensitisation Teledermatology: A Review and Update A longitudinal study of consistency in diagnostic accuracy of teledermatology tools A systematic review of satisfaction with teledermatology Teledermatology for COVID-19 cutaneous lesions: substitute or supplement?