Snapshot
- A 2-year-old girl is brought in by her parents due to a rash on her armpit and belly for 2 weeks. Her major complaint is itching. The lesions are so itchy that she cannot sleep at night and scratches her rashes constantly. She goes to daycare 3 days a week. Skin exam reveals multiple polymorphous scaly papules on her hands, in the axilla, and around the umbilicus. A skin scraping with mineral oil prep reveals mites under microscopy.
Introduction
- Superficial skin infection caused by arthropod Sarcoptes scabiei (mite)
- Severe itching at night
- Too small to be seen by naked eye
- Pathognomonic sign
- burrows, linear markings in skin due to mites’ movements
- Risk factors
- close contacts with scabies
Presentation
- Symptoms
- hallmark feature
- itching worse at night
- hallmark feature
- Physical exam
- adults
- burrows, especially in between finger web spaces
- linear markings in skin with some scale
- erythematous, inflamed pustules and papules
- commonly on wrist, finger webs, axillae, chest, umbilicus, genital area
- children
- generalized pruritic rash
- adults
- scalp may also be involved
Evaluation
- Diagnosis based on clinical exam and history
- Diagnosis confirmed with simple office procedure
- skin scraping with mineral oil prep
- can see mites under microscopy
Differential Diagnosis
Treatment
Prognosis, Prevention, and Complications
- Prognosis
- very good
- Prevention
- avoid those with known scabies
- treat all known contacts