In 2004, Robert Clark, a physician who specialized in infectious diseases and was a researcher at NIH, developed an angry rash which eventually spread over his entire body. It got so bad he would wake up with bloody fingernails from scratching his skin raw. He saw numerous doctors, including three dermatologists, internists and infectious disease specialists, all of whom were stumped by his uncontrollable itching and scratching.
After he became so disabled by the pain and itching that he had to stop practicing, his most current doctor, an immunologist (who was prescribing narcotics for pain) told Clark he wanted him to see one more dermatologist. At first Clark resisted, but finally agreed.
Even before he entered the examining room to meet his new patient, dermatologist Howard Luber was confident he knew what was wrong with the man.
The diagnosis was so obvious, Luber recalled, that his nurse suggested it after taking Robert Clark's history and looking at the angry, encrusted rash that blanketed nearly every inch of the 64-year-old's body except his face.
Clark recalled that Luber was in the room less than a minute when he said, "You will be feeling better in a few days." The dermatologist then gently scraped Clark's inflammed, leathery skin and had him look at the slide under the microscope. The problem was immediately obvious: The skin sample was teeming with a common parasite called scabies, a tiny mite passed from direct contact with an infected person.
The eight-legged mite thrives in over-crowded conditions or among people with substandard hygiene, but it can affect anyone, according to the American Academy of Dermatology.
Outbreaks have plagued humans for more than 2,500 years and can occur in institutions such as homeless shelters, nursing homes, and sometimes hospitals.
Diagnosis may be delayed because scabies mimics other skin conditions and mites are difficult to see with the naked eye. Its most characteristic symptom is itching at night so ferocious it can keep sufferers from getting any sleep. The mite burrows into the skin, laying eggs and producing toxins, causing an allergy that triggers the itching. Mites are attracted to the warmth and human scent, and can live up to 24 hours on bedding.
Clark had the most severe form of scabies, called Norwegian or crusted scabies. In these cases, thousands of mites hide under the skin, which becomes thickened, retarding penetration of topical medications.
Treatment with topical medicines and, in severe cases, an anti-parasitic drug called ivermectin--is standard, and the residence of an infected person must be thoroughly cleaned and clothing washed in the hottest water possible. All members of a household must be treated, because the incubation period can be as long as eight weeks.
"It's pretty hard to believe," said Dr.
Luber, who called Clark's malady "bread and butter dermatology. "I don't have a good explanation for why his problem went undiagnosed for so long." Maybe, he suggested, doctors were focused on more severe disorders,and the skin's worsening appearance camoflaged the underlying problem. "If you're not thinking of it, you could miss it."
www.washingtonpost.com/medical mystery
(7/19/08)
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Topic: Doctor, doctor! Help! (scratch, scratch) (Read 346 times)
