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Updated: Nov 30 2020

Scabies / Itch Mite

  • 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
    • 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
        • 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
    • Chiggers
    • Bedbugs
    • Contact dermatitis
  • Treatment
    • Topical permethrin
    • Sterilize laundry
      • wash/dry all clothing with high heat or throw away
  • Prognosis, Prevention, and Complications
    • Prognosis
      • very good
    • Prevention
      • avoid those with known scabies
      • treat all known contacts
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