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