Norwegian Scabies in an Atopic Patient under Dupilumab Treatment
Bibliographic record
Abstract
PRÉCIS We present a case of Norwegian scabies in an atopic patient receiving dupilumab treatment. DISCUSSION A 23-year-old male patient with an autistic disorder, treated for severe atopic dermatitis with dupilumab 300 mg every 15 days for the last 4 months, revealed at the follow-up consultation a 2-week history of acute hyperkeratotic plaques and pruriginous vesicles. The flexures, the periumbilical region, and the hands were the most severely involved areas (Fig. 1). Before dupilumab treatment, he had no signs of hand dermatitis. In addition, his mother presented pruriginous interdigital vesicular lesions and reported pruritus in his father and in her 1 month before consultation.Figure 1: Hyperkeratotic plaques and pruriginous vesicles involving the hands.At the time of consultation, the simultaneous study of scale scraping in the patient and his mother revealed Sarcoptes scabiei under the microscope. Dupilumab was temporarily discontinued, and treatment with ivermectin 14 mg (scheduled on days 1, 2, 8, 9, and 15), concomitantly with topical applications of 5% permethrin and 5% salicylic acid in petrolatum, was established. Three weeks after the treatment, the patient was free of keratotic and vesicular lesions, and dupilumab could be restarted. The mother and father were treated with topical applications of 5% permethrin repeated 1 week later. Dupilumab blocks the activity of interleukin 4 (IL-4) and IL-13, 2 key cytokines of the helper T cell 2 immune response that are essential in fighting parasites.1 Although no data on a possible increase of Norwegian scabies with dupilumab therapy have been reported up to date, cases have been published in the context of other biological therapies that inhibit important cytokines of the helper T cell 2 route (anti–IL-23, anti–tumor necrosis factor).2–5 PEARL Norwegian scabies should be considered in any outbreak of new-onset pruritic dermatitis in dupilumab-treated patients.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".