{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T16:07:06Z","timestamp":1779466026760,"version":"3.53.1"},"reference-count":28,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,5]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>We report the case of a woman in her 20s from rural Myanmar who developed severe crusted scabies following the prolonged use of unlabelled traditional herbal remedies for rheumatoid arthritis. While her joint symptoms improved, she developed a rapidly progressive, hyperkeratotic and pruritic rash. A clinical diagnosis of crusted scabies was made based on the characteristic morphology and evidence of uncomplicated scabies in household contacts. Treatment included a prolonged course of topical benzyl benzoate and environmental decontamination. Ivermectin was unavailable due to national supply chain disruptions. The patient achieved complete remission after discontinuing the herbal remedies and completing the scabicide regimen. This case highlights the risk of iatrogenic immunosuppression from unregulated traditional medicines and underscores the need for better regulatory oversight and essential medicine access in conflict-affected regions.<\/jats:p>","DOI":"10.1136\/bcr-2024-263516","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T15:40:20Z","timestamp":1779464420000},"page":"e263516","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Immunosuppressive traditional herbal remedies in Myanmar (Burma) as a potential trigger of severe crusted scabies"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1119-4691","authenticated-orcid":false,"given":"Cassim","family":"Akhoon","sequence":"first","affiliation":[{"name":"Clinical Immunology and Allergy, King\u2019s College Hospital, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwee Chyen","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Dermatology, KK Women\u2019s and Children\u2019s Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"2026052208401304000_19.5.e263516.1","first-page":"106","article-title":"Medicinal plants: source for immunosuppressive agents","volume":"2","author":"Sahoo","year":"2018","journal-title":"Immunol Curr Res"},{"key":"2026052208401304000_19.5.e263516.2","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.intimp.2005.09.012","article-title":"Brazilein, an important immunosuppressive component from Caesalpinia sappan L","volume":"6","author":"Ye","year":"2006","journal-title":"Int Immunopharmacol"},{"key":"2026052208401304000_19.5.e263516.3","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.1111\/ijd.17327","article-title":"Clinical practice guidelines for the diagnosis and treatment of scabies","volume":"63","author":"Uzun","year":"2024","journal-title":"Int J Dermatol"},{"key":"2026052208401304000_19.5.e263516.4","doi-asserted-by":"crossref","unstructured":"Graham-Brown RAC , Bourke JF , Bumphrey G . 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