Misdiagnoses and Psychosocial Implications in Patient with Crusted Scabies: A Case Report

Background: Misdiagnoses in crusted scabies frequently arise from its overlapping clinical features with other dermatologic conditions, which often result in inappropriate corticosteroid administration that exacerbates disease progression. Prolonged delayed correct diagnoses and treatment further contribute to substantial psychosocial distress in affected patients.

Case Presentation: A 22-year-old female with a six-month history of widespread pruritic erythematous papules and plaques, initially misdiagnosed and treated with multiple courses of corticosteroids. Prolonged immunosuppressive therapy for 6 months facilitated disease progression. She also had a history of depression. Dermoscopic and microscopic evaluation confirmed the diagnosis of crusted scabies. The patient exhibited significant psychosocial burden, with moderate depression, anxiety, and social withdrawal. Psychiatric evaluation revealed bipolar affective disorder, current episode severe depression with psychotic features, and borderline personality disorder which considered related to the previous history of depression and prolonged corticosteroid medications.

Conclusion: Delayed diagnosis of crusted scabies not only exacerbates physical disease but also imposes significant psychological and social burdens. Early recognition, appropriate scabicidal therapy, and multidisciplinary management, including psychiatric support, are essential to improve outcomes and quality of life in affected patients.