Scabies and the Potential Aftermath of Acropustulosis
Someone requested that I write a post about scabies and acropustulosis a LOOOOONG time ago, but at the time, I didn’t think it was relevant to very many of my readers since scabies has been written about often and acropustulosis is considered to be pretty uncommon. I think it was probably more relevant than I realized, and I just got another request to write on this topic. Sorry to whomever made the initial request that I ignored until now! Better late than never, right?
Hopefully this post will be useful to those readers who have adopted, or will adopt from an orphanage with the oh so familiar scabies epidemic. Jackson’s orphanage in Vung Tau was pretty much crawling with them, and every baby we knew coming out of there had a decent to bad case of scabies. Shane’s orphanage, on the other hand, in Que Son, was TOTALLY scabies-free. It was amazing. Shane left that place with GORGEOUS skin, and still has gorgeous skin. Jackson, on the other hand, still suffers from his post-scabies skin problems, along with his eczema.
Most people already know you should bring a few tubes of Elimite with you, which is a prescription topical cream that gets rid of the scabies mite. Ok, I’ll back up. Scabies is a dermatologic condition that results from the body’s immune response to the eggs of the scabies mite. It’s commonly found in unclean conditions where people tend to be crowded together (prisons, orphanages, homeless shelters, etc.). The mites burrow under the skin, lay their nasty eggs, which causes the body to react with itching and red “bumps.”
Here’s a picture of a scabies rash:
In case that didn’t already gross you out, here’s a microscopic picture of what the mites look like:
They love to burrow in the creases between fingers, toes, and in the natal cleft (butt crack), so those are good places to check if you’re not sure if your child has scabies. Because live mites and eggs are involved, scabies is a contagious condition. However, it’s not nearly as contagious as everyone treats it unless your child has the most severe infestation (Norwegian Scabies) and you have a lot of contact with his/her skin before you treat it with Elimite. You’re most likely not going to catch it from holding your baby that first day. But if you want to be extra careful anyway, put your clothes with your baby’s clothes in a separate bag to take home and wash on high heat. Anyway, here’s my advice:
- The first night you come home from the orphanage with your child, you should cover them head to toe (avoiding the eyes) with Elimite. I would do this even if you aren’t sure of the diagnosis, but see red bumps that seem to itch. It’s a pretty benign treatment, and imo, the potential of getting scabies or having your child continue to suffer with them in the midst of his/her transition into your care is worse than the treatment. The guidelines are to “treat all contacts,” but unless you’ve waited to initiate treatment with Elimite and have been co-sleeping or living in very close quarters with your child longer than just that first day, it’s highly unlikely you get scabies if you treat right away. So, imo, if you slather your child in Elimite the first night, you shouldn’t need to treat the other family members who were present that first day.
- Put the clothes they were wearing in a separate baggie to wash with high heat when you return home (most people keep that orphanage outfit as memorabilia for their child).
- When your child wakes up, which hopefully doesn’t happen until the next morning (HAHAHA, yeah right!), bath them to remove the Elimite. This should be sufficient to get rid of the scabies. VERY rarely will a child require a 2nd application of Elimite.
However, successfully getting rid of the mite does not ensure you are totally done with this issue. I’m talking about a skin condition called infantile acropustulosis, which is commonly reported after a bout of scabies has been treated. It doesn’t require scabies to have ever been present, but it does often follow a known case of scabies. Initially, it was thought to be a persistent immune response despite the mite having been eradicated. It’s now known that it is not an immune problem, and it’s not a result of the mite recurring. The etiology is unknown and it’s a pretty poorly understood and under-recognized condition. It’s also not contagious. It is more common in darker skinned people and usually presents with vesicles, or fluid-filled bumps, on the palms of the hands and soles of the feet (here are 2 good pictures), although in rare cases the vesicles can be on the trunk, face, or scalp as well. The vesicles itch like hell, and probably cause your baby/child a lot of discomfort. They also seem to be cyclic, so they’ll come and go. Sometimes they last a few days, sometimes longer, and they tend to recur every few weeks. The outbreaks are self-limited, meaning they resolve on their own and there’s really nothing you can do to hasten the resolution. You can treat the symptoms with a topical steroid (like hydrocortisone cream), or an antihistamine. Occasionally, pediatric dermatologists will use dapsone for really severe, refractory cases. Your child will eventually grow out of the outbreaks altogether, thankfully! Most doctors are NOT familiar with acropustulosis, and it’s believed to be underreported because there’s not much awareness about it. Also, many doctors misdiagnose this as a scabies recurrence because they’ve just never heard of it, in which case they’ll have you using Elimite over and over with no results. I had to tell our doctor about the condition, and she’s a really informed physician!
Jackson has acropustulosis, although he hasn’t had a flare in a few months and I’m praying he’s finally outgrown it. During the flares, the itching bugs (no pun intended) the heck out of him. He sometimes comes hopping towards us with 1 foot in the air saying “itch, itch!” On occasion, he even has a hard time falling asleep because his poor little feet itch so badly. On those nights, we give him Benadryl and apply a topical steroid. We’ve learned to cover the hydrocortisone cream with a layer of aquaphor to seal it in so it doesn’t just rub off. That helps a little bit, but it still really stinks when he has an outbreak.
Just out of curiosity, how many of your kids out there have acropustulosis? If so, what did you have to go through to end up at that diagnosis (was your child given several rounds of scabies treatment? skin scrapings? etc.)?
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26 comments
wow, this is one of those weird coincidences. I just heard about acropustulosis on Sunday from a fellow adoptive parent who also adopted from Vung Tau (in 2003). Both my kids are also from Vung Tau, but from two different centres (my daughter and my friend’s son are both from the same centre as Jackson). Both had scabies, but neither had acropustulosis (thank heavens). During our second adoption in 2006, we did all end up getting scabies unfortunately, and man, did it give me sympathy for what those kids are going through. The itch was unbearable…(The laundry wasn’t too much fun either!)
(not about scabies…but this post got me thinking) Have you thought about doing peds and then going into adoption medicine? It wouldn’t have procedures– but you’d be SO helpful to parents…
My daughter didn’t have scabies when we picked her up-but does have very sensitive skin and every so often, breaks out in what the doctor has called folliculitis (sp?). They usually start on her back and start as red welts and turn into little acne-like bumps. This spreads a bit, sometimes to her face or belly (maybe 10-15 “pimples”). They don’t seem to bother her so I guess it’s probably not acropustulosis. But the doctor has diagnosed this over the phone just by my description-because she never has an outbreak when I go in with her and it has never seemed serious enough to either of us to bring her in when it does happen. Know anything about folliculitis?
Angelica (from Guatemala) had a severe case of scabies. It took 2 Elimite treatments and I treated myself since I had been with her for 3 plus days before receiving a proper diagnoses (we were unaware of scabies and the orphanage never said a word when I picked her up.) Anyway, she never had acropustulosis (that I know of but due to her having so many skin conditions, it wouldn’t surprise me if she had it and I was unaware) but did have severe, I am talking head to toe, eczema for 5 months straight with no end in site. Mixed in with her eczema was Molluscum Contagiosum some form of the pox virus (have you heard of it?) The Molluscum I finally diagnosed after much internet research and after taking her to 2 docs in Guatemala, 2 docs in the US and a very well known dermatologist (is a college professor and has written many derm books.) Those little stinkers (molluscum bumps) took 2 years to get rid of…finally went away on their own but 2-3 bumps appear once in a while still to this day. Angelica continues to have bouts of eczema and very sensitive skin. I am convinced that this all stems from the unclean orphanage. Thanks for all the information; it will be very useful for when/if we bring home our boy.
BTW, I like the idea the above poster had…you doing peds and then going into adoption medicine.
We adopted both of our kids from Thai Nguyen and were told that our daughter (Isabel) had scabies but not our son (Jackson). So on the first night we treated Isabel. A few days later Jackson was itching so they said to go ahead and treat us all. After we returned home Isabel stopped itching but Jackson went “on & off” for months. We went back and forth to the pediatrician and he finally gave up and sent us to an allergist. They did the skin tests and came back to us with a long list of foods that were causing his rash and itching (his back breaks out first and then moves to a few little bumps on his stomach). He is allergic to: pork, eggs, shellfish, melons, carrots
(How my poor baby would have survived in VN is beyond me!) Anyway, I am very careful about what he eats but on maybe 3 occasions he has broken out and I have no explanation in regards to his diet. So thank you for the new info. I’ve never heard of acropustulosis but I will look into to see if it’s possible
I can’t believe it. That’s exactly what Rion has. We took him the Dr’s this week and they couldn’t figure it out but thought it was hand, foot, mouth disease… We’ve known he’s had scabies since last October and we finally were able to get him from his orphanage late June. It took 2 treatments of Elimite, they just wouldn’t go away. THANK YOU(!) for information, he’s been so upset and uncomfortable (lots of huge blisters on his feet, lots of little ones on his hand, two large clusters elsewhere. I’ll take him to the derm. w/ this info. Again, thanks so much. If you have any other and can post, we’d appreciate it. M
We were advised to take Elimite with us when we went for pick-up in one of our adoption packets. When I called the peds office the two nurses laughed at me and said that I had no business trying to self diagnose when I was there. O.k., so I called our agency and they said “No, you have to get the stuff here.” O.k., so I called the peds office back and they refused to give me a prescription without seeing the child. It all ended fine (changed peds office and Julia didn’t have scabies) but it was frustrating to have a lack of support from the medical profession.
What are you doing to treat the eczema? We can’t get Julia’s to go away with anything that we put on it.
Maureen, my little sister was adopted from Russia and, after scabies, also had what i now know was acropustulosis. It was also misdiagnosed as hand-foot-mouth, as acropustulosis frequently is. And the docs are always perplexed as to why nothing is in their mouths, but they still settle on that as the diagnosis. When it recurs they’re TOTALLY stumped. So yeah, google infantile acropustulosis and print out the Emedicine article that’s written for physicians and bring it with you next time. Just bring it up gently b/c some docs really get their feathers ruffled when patients diagnose themselves or their own kids (but you have EVERY RIGHT to be an informed patient and sometimes docs need more help from their patients!!).
Nora, we are HUGE aquaphor ointment advocates for eczema over here. What I recommend is less frequent bathing (like 2x a week) to prevent drying her skin out…counterintuitive, but bathing actually causes a lot of moisture loss. When you do get her out of the bath, dab her dry so that some of the moisture remains on her skin. Then LATHER her in Aquaphor like a greased piggie. Gross, but it works. For the really bad patches, we use desonide ointment from time to time. It’s a low potency steroid - prescription. We use Aveeno hydrocortisone 1% for the patches on his trunk, arms, legs…you have to be careful using steroid creams / ointments on thin-skinned parts of the body like the face bc over time it thins the skin further. You don’t want her blood vessels showing through her skin bc you’ve overused steroids on her face, so just be concientious of that. Also, for eczema, just remember that water-based lotions or creams are no good. They end up causing more moisture loss throughout the day, whereas ointments (the greasy preparations) seal it in.
nothing to do with scabies…BUT i figured out your perfect profession:
Physical Medicine and Rehabilitation!!! seriously, zero call, you work 9-3, there are definately procedures, great reimbursement, low malpractice. i was so close to choosing this and then at the last minute i went with OB/GYN!!! Major call, work hours are 5:30a.m-7p.m., crappy reimbursement, and crazy malpractice. what was i thinking??? but seriously, have you considered PM&R? it would be great for a young active mom.
Hey, thanks for the info. I think that is what Bella has too. It’s been a whole month since we’ve been back and she/we still itch and Bella has papules on her back and face which will not go away. We are just sick of smothering on the Elimite cream but her pedia. can’t tell us anything new. Really good advice on the scabies treatment but when we landed in VN they lost our luggage with the Elimite so Bella did not get treated until her scabies passed over to us and it’s been hell trying to clean everything at home. I swear if we have to wash EVERYTHING all over again one more time our washer will give up and retire and just when our warranty ran out on it too. One thing though, why when we use the Elimite then the very next day her papules would get better and dry up but only to come back at exactly 2 weeks later? I thought maybe she has the resistant kind but her rash isn’t crusty at all. I am so ready to put the scabies thing behind us and move on to better things like go have professional pictures of Bella at 1 y/o this month.
Laurie, thank you for posting about this topic. I ‘think’ I had actually written you about acropustulosis long ago (while searching for info.) and then again recently, so THANKS! I know you are very busy, but I want you to know I appreciate all of your posts.
Tianh had horrible skin when we got her. She was covered in scabies and had large dark spots on her torso that are believed to be tick bite granuloma. The tick bite granuloma spots continue to reappear if she is stressed, sick, or very tired. When they appear, they look just like she was bitten by mosquitoes; however, they appear in the same place every time. Have you heard of this?
Her pediatrician had a hard time figuring out what the tick bite granuloma was and we actually found out about it through an international doctor at Vanderbuilt (via another family who adopted from the same orphanage). As for the acropustulosis, the pediatrician was perplexed because he knew she didn’t still have scabies (or we would have it, too) so he went online to a VN site to try to find some answers. He told us on our follow-up visit that it was acropustulosis. This doctor never stops until he finds answers! We are blessed! Even though he knew what it was, he wasn’t able to give us much information. I have many friends who have adopted, and their pediatricians continue to treat it as scabies. I have a feeling your post will help many, many families (and doctors). By the way, is Eliminite as toxic as people say? We were encouraged not to use Eliminite more than 2 - 3 times due to the toxicity (sp?). I’m just curious about this and have tried to find info.
When Tianh’s acropustulosis is bothering her, I have found that Dimetapp Cold and Allergy works better than the Benadryl. A pharmacist actually recommended that I try this because it has a different type of antihistamine. It does seem to give her better relief than Benadryl.
Laurie, thanks again for your posts. What a blessing your insights and knowledge have been to so many of us.
Take care and blessings to your family!
Binhjamin is from Vung Tau, same place as Jackson, but his scabies seemed to have been treated when we brought him home. Still, I was like a paranoid woman and treated our whole family that first night. No problems from the scabies since then, but he does have acropustulosis. Of course, his case isn’t like the pics from the link you had (those derm. pics are like always worst case scenerios, it seems. The ones they have for diaper rash make me shudder..) but he gets little bubbles on his hands/feet at random times. They don’t seem to bother him that much, though, thank goodness. He’ll scratch a little, but they go away in a couple of days.
This is a GREAT post Laurie! Thank you for clearing that up for me! Both of our boys had scabies, Cameron’s were especially awful. Apparently, they also had acropustulosis although we were misdiagnosed as recurrent scabies. We probably treated all of us at least 3 or 4 times with Elimite. They haven’t had any more outbreaks though in at least a year which is great! I see many of your readers posting that they have or are adopting in Vung Tau and I just wanted to share with everyone that Cameron also apparently had picked up MRSA/staph from that orphanage. It looked like little boils on his shoulders, upper arms, and upper back. They were below the surface and never burst (he has very thick skin). The infection spread to Connor once we were home who got a HUGE nasty boil on one shoulder which burst (gross! gross! gross!). None of the doctors we were seeing at that time were able to take a sample of the puss (I cleaned up Connor’s pussy mess) and didn’t want to cut open one of Cameron’s deep boils to confirm the suspected diagnosis of MRSA, it was assumed based on the symptoms. We were quarantined at the hospital when Cameron had to have a minor unrelated surgery. Our entire family did a 10 day intense treatment involving laundry to the n’s, Hibiclens and Batroban cream medicine under our noses. That appeared to do the trick and none of us have had any issues since. I just wanted everyone to be aware how NASTY Jackson, Cameron and Connor’s orphanage actually is to come out THAT infected! On a high note, we took the boys to an immunologist due to some blood test that had unusual results. Despite the boys’ rough beginnings, he felt the boys would actually have superior immunities due to exposure to parasites we just don’t have in the states. He didn’t want to see them again unless we started having issues which we have not.
Oh my gosh!! THANK YOU for writing this post!!! (I have been following your blog for a long time but have never commented) We have been having sooo much trouble with scabies. Our daughter has been home since May 9th. But now I am wondering if she has acropustlosis. I have never heared of that. Would you mind terribly emailing me? If I could give you the run down on what has been going on I would appriciate it soooo much! I know you are busy with your 3 little ones - but I think you might be able to really help us. We have used the Elimite twice and two different “natural” sprays I got off two different web sites. WE have been to the dermatologist but that didn’t help. Again, thank you thank you for writing this!
Kim Wheaton
http://www.weareblessednotlucky.blogspot.com
Thank you for educating us. I don’t yet have a child, but I’m trying to prepare for things like this.
Thanks Laurie. I’ll do that. This helps.
M
Wow - very interesting. My daughter is home six weeks now. She did not appear to have scabies when I got her (and the SOS clinic said she did not) but I treated her anyway because several babies previously from her care center did have it. However, after being home three weeks, she was diagnosed with a mild case of hand, foot and mouth….but had nothing in her mouth. It resolved itself pretty quickly with no treatment (within a week). However, now I am wondering if that wasn’t a misdiagnosis as well. I will definitely keep a watch on this. Can kids get acropustulosis at varying degrees? If that’s what my daughter has, the breakout was about 1/5 as bad as those pictures and she did not seem to itch much.
Thank you for sharing this information.
Wow, I wish I had read this post two years ago. Camille developed hand and foot “blisters” that looked exactly like that. We were out of town and were prescribed Mupuricin (sp) and that took care of it. It has never returned, and we don’t know of any scabies in her history, but is likely since other kids at her orphanage had it. All the kids in our group had vicious boils on their heads from laying on the straw mats, though. Also treated with Mupuricin and cleared right up while in Hanoi.
I love your blog, and wish your incredible family the best. I don’t know where you find the time to post such thoughtful entries constantly.
Frances
Ughhh, gross pictures! Thanks for such a great (and easy to understand) explanation of these conditions. We did exactly what you explained - we treated Lilly (and ourselves) the first night we had her, and we have not had any problems with scabies since we returned 4 weeks ago. Hopefully nothing will pop up out of nowhere…
I haven’t had much time to comment lately, but I’m really enjoying following along on your life/work balance posts…It such a big issue for so many of us, and I totally admire that you are taking the time (and have the courage) to write about it. I hope you’re able to find the specialty that meets all your needs. Maybe Infectious Disease? Seems like that would serve you well overseas, too… In fact, what about Pediatric Infectious Disease with an emphasis in International Adoption? You could be the next Jane Aronson!
I’m quite certain my daughter currently has acropustulosis although my pediatrician diagnosed the blisters on her hands and feet as viral and prescribed Zovirax. Are these blisters viral? (My science background is lacking to say the least.) My daughter came from the same orphanage as Jackson. She did not appear to have scabies when I got her, but I did do the Elimite as a precaution. She had the blisters when I first brought her to the States and then they went away(at the time I was using hydrocortizone and will go back to using that) but now they’re back.
Our daughter is suffering from acropustulosis. We met her in June after she had been in the orphanage for a year. I’m guessing she had scabies from a very young age. We treated her with the French spray (can’t remember the name-got it at the SOS clinic) the day we met her (we treated ourselves as weel). The active scabies got better in a matter of days however, the acropustulosis kicked in almost immediately. She is still suffering from the acropustulosis two months later-they come and go and each time they go I pray they don’t come back. The interesting thing is that each time they reoccur they seem to not itch her as much. I’m hoping this is a sign they are starting to go away. I am treating her with an all natural skin cleaner that seems to work well during her outbreaks, but for now, I believe that’s all I can do. I’d love to hear more about this if you have any further info and/or time to post more on this subject. I know of at least 3 other babies suffering from this (all from the same orphanage as our child, Thai Nguyen.) Thanks for posting about this!!!
I think my daughter has this as well- clear fluid filled blisters on her fingers and a few on her feet? She came from Go Vap and had scabies, which we treated X2. These lesions are also on her scalp in a few places. Please clarify… this is NOT contagious? Just treat with topical steroid if needed for itching? Her skin was horrific when we got her, and is much better now, but noticed these fluid filled blisters yesterday. Any other advice is appreciated. Thanks!
My daughter does not have it, but I do. I asked the pediatrician if it could be scabies, he thought not. I have not had it evaluated more than that, but treat it the same as my more usual dermatitis - with the corticosteriod. Unfortunately (for a doctor this probably does not seem to be a good idea) when it is most painful, I will break it (usually only occurs in 1-3 pustules) open and drain it, relieving the pain. Usually it resolves within 1 day or so. I have been getting them for many years and they recur in the same location.
Hi! Thanks for writing about post scabies as we are going through it with our little girl adopted two months ago from Vietnam (Thai Nguyen). Please email me privately as I would love some help on how you dealt with it…our little one has it even in her diaper area and it breaks my heart. Nothing seems to help it go away and I worry about infection when the blisters occasionally pop. We go back to the doctor this week, but she is not aware of the condition and her dermatologist gave a script that doesn’t do much either. Benedryl helps her sleep and not itch at night. She is a trooper with them!
[...] school and am currently doing dermatology research in Colorado. Some of you might also remember a post I wrote about a year ago about one of Jackie’s skin conditions, called ACROPUSUTULOSIS (aka infantile acropustulosis, acropustulosis of childhood, or acromelanosis). I was shocked by [...]
Thank heavens for someone out there that could tell me what the heck was going on with my son. His foot as well as his hands looked like he got the infestation again. Two days later when i took him to see his doctor they looked like they were gone and all that was left was dry little skin spots everywhere. The doctor told me he did not know if they were recurring or if they were healing. He gave me the steroid cream for it just like you said. He did however tell me if I saw a recurrence to come back in and he would treat all of us again. So i went online to find answers and i could not find any until i stumbled on your website. Thank you now I’m not so worried. It just really sucks!!!
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