REVIEW – January 2019

Scabies is not always expressed as classical rash

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Scabies is an infectious disease of the skin caused by the parasite Sarcoptes scabiei var. hominis. The prevalence of scabies remains between 0.2% and 71.4%. Mites are transmitted by skin-to-skin contact. Classical scabies occurs in persons with normal immune response. Eruption consists of small, erythematous, excoriated papules disseminated between the fingers and on the wrists, periumbilical area, breasts, axillary folds, buttocks and genitals. Crusted scabies occurs in immunocompromised patients and is characterized by generalized, erythematous eczema-like patches or psoriasiform scaling plaques. The skin and scales contain numerous mites and even brief contact causes outbreaks of scabies among healthcare workers in nursing homes and care facilities. Scabies is diagnosed by history and clinical signs of the skin. Mites are identified by dermatoscopy, microscopy and skin biopsy. Recommended medications for treatment are topical permethrin and oral ivermectin. Sulfur ointment has been suggested as an alternative scabicide. All contacts must be treated at the same time.