Bullous pemphigoid is a severe autoimmune blistering disease, and Norwegian scabies is a rare comorbidity. However, conventional treatment methods, such as systemic corticosteroids, carry a high risk in the treatment of elderly patients. Herein, this rare comorbidity is described in an elderly patient. After an initial induction treatment with a low-to-moderate dose of corticosteroid, this patient achieved complete remission with a combination therapy of dupilumab (a monoclonal antibody targeting the interleukin-4/13 signaling pathway) and ivermectin. Therefore, the successful treatment of this rare case provides a promising strategy for reducing reliance on corticosteroids in high-risk populations.

Topical permethrin (5%), though considered the treatment of choice for scabies, has few drawbacks (expensive, poor compliance). This study aimed to compare the efficacy, safety, and cost-effectiveness of topical permethrin (5%) and oral ivermectin for treating childhood scabies. This randomized controlled trial was conducted in the dermatology and pediatric outpatient clinic of a tertiary care center between August 2023 and December 2024. Children in the study and control groups received oral ivermectin (200 µg/kg) and 5% permethrin, respectively, at an interval of 7 days. The cure rate at the 4th week was the primary outcome. Secondary outcomes were cure rate (1st and 2nd week), lesion count per patient (1st, 2nd, and 4th weeks), microscopic clearance (1st, 2nd, and 4th weeks), treatment failure (4th week), adverse events, reinfestation at the 6-month follow-up period, and cost to successfully treat one case. Three hundred and fifty-five children were included in either group. Though a significantly higher proportion of children in the control group were cured at the 1st week (41.8% vs 62.9%, p-value <.001), the cure rate was similar between the groups at the 2nd and 4th weeks (P-value >.05). Treatment failure was also similar in both groups (5.1% vs 3.9%, P-value = .47). The cost to treat one case successfully in the study and control groups was ₹44.2 ($0.46) and ₹140.4 ($1.47), respectively. Reinfestation during the follow-up period was similar in the two groups (P-value >.05). Oral ivermectin may be a cost-effective alternative treatment of childhood scabies. The trial was registered in the Clinical Trial Registry of India (Registration no.: CTRI/2023/07/055910, dated 31 July 2023).

Scabies, caused by Sarcoptes scabiei var. hominis, remains a major global health problem affecting both resource-poor and high-income regions. Despite the availability of effective treatments, treatment failure continues to pose a challenge to disease control and has become an increasingly recognized clinical and public-health concern. However, treatment failure is often attributed solely to drug resistance, overlooking the complex interplay of biological, clinical, behavioral, and environmental factors. This narrative review summarizes the current state of knowledge regarding the multifactorial causes of scabies treatment failure. Key areas include true parasitological failure, pharmacological limitations, and emerging resistance; pseudoresistance resulting from incorrect treatment administration; reinfestation from untreated contacts; environmental transmission; diagnostic uncertainties; and host-related inflammatory reactions such as postscabies pruritus. The review also proposes a multidimensional conceptual framework to distinguish true treatment failure from apparent clinical failure and to explain how interacting factors contribute to unsuccessful treatment outcomes. Identifying these determinants is crucial for optimizing treatment strategies, improving treatment success, and guiding future research aimed at combating scabies.

Working definitions of a sexually transmitted infection (STI) exist, but no universally agreed operational classification links those definitions to programme, funding, and surveillance decisions. The boundary of the STI category determines which infections enter surveillance, receive programme funding, and are included in testing and screening. Yet, the fields of microbiology, clinical medicine, and public health each define this boundary differently. Contested conditions, including bacterial vaginosis, vulvovaginal candidiasis, scabies, mpox, and sexually transmissible enteric pathogens, expose the inadequacy of the current binary classification. In this Personal View, we propose a three-tiered classification framework: core STIs, sexually associated infections, and incidental sexually transmissible infections, anchored on four explicit classification dimensions. The framework is intended to guide programme mandates and funding, clinical and diagnostic service delivery, and disease surveillance, while accommodating conditions that might shift between tiers as evidence evolves and as local epidemiology dictates. We also discuss the unintended consequences a formal classification could have for equity, stigma, and resource allocation. A graded classification acknowledging degrees of sexual transmissibility is more useful than a binary classification that forces false clarity.

Potato common scab (PCS) is an economically important soil-borne disease whose occurrence is governed not only by pathogen virulence but also by the disease-associated microbiome and soil environment. However, studies on natural bioactive compounds have primarily focused on direct pathogen inhibition, whereas their roles in microbiome remodeling remain largely unexplored. Here, we investigated the antibacterial activity of kojic acid (KA) and ε-poly-L-lysine (ε-PL) against Streptomyces scabies and evaluated their effects on PCS severity and the tuber-associated microbiome. Both KA and ε-PL significantly inhibited the growth of Streptomyces scabies G9, with ε-PL exhibiting stronger in vitro antibacterial activity. Both treatments disrupted hyphal ultrastructure, increased membrane permeability, and triggered extensive transcriptional reprogramming involving cell envelope organization, central metabolism, membrane transport, and genetic information processing. Net-house and field trials showed that both compounds substantially reduced disease severity; significant yield increases were observed in the net-house trial, whereas no significant yield differences were detected among treatments in the field trial. Microbiome analyses revealed that both compounds improved the physicochemical properties and enzyme activities of tuber-associated soil, reshaped the composition and predicted functional profiles of the tuber-associated bacterial community, and reduced the relative abundance of pathogen-associated Streptomyces taxa. Correlation analyses revealed significant associations among soil environmental factors, pathogen-associated Streptomyces taxa, and disease occurrence. Collectively, these findings indicate that KA and ε-PL suppress PCS in association with direct antibacterial activity and remodeling of the tuber-associated bacterial community. This study provides insights into the potential roles of natural bioactive compounds in pathogen suppression and microbiome modulation.

Atypical infantile scabies is easily misdiagnosed as common inflammatory dermatoses, leading to therapeutic delay. This 11-month-old female infant presented with two months of generalized pruritus and steroid-refractory palmoplantar pustules, which failed to respond to topical glucocorticoids and calcineurin inhibitors. Epidemiological inquiry revealed familial clustered pruritus and definite occupational scabies exposure in her mother, a ward nurse. Dermoscopy directly identified mites and confirmed the diagnosis. Standardized sulfur ointment treatment for the infant and synchronous eradication therapy for all household members achieved remission. This case highlights that anti-inflammatory-refractory palmoplantar pustules are crucial red flags for atypical infantile scabies. For intractable eczema-like eruptions in infants, targeted contact tracing and dermoscopic evaluation should be prioritized over prolonged empirical anti-inflammatory therapy to enable early and accurate diagnosis.