Scabies - Epidemiology, Clinical Features, and Diagnosis

21/2/24, 19:48 Scabies: Epidemiology, clinical features, and diagnosis - UpToDate
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Scabies: Epidemiology, clinical features, and diagnosis

AUTHORS: Beth G Goldstein, MD, Adam O Goldstein, MD, MPH
SECTION EDITORS: Robert P Dellavalle, MD, PhD, MSPH, Moise L Levy, MD, Ted Rosen, MD
DEPUTY EDITOR: Abena O Ofori, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jan 2024.

This topic last updated: May 24, 2022.
INTRODUCTION
Scabies is an infestation of the skin by the mite Sarcoptes scabiei ( picture 1A-B). Classic
scabies typically manifests as an intensely pruritic eruption with a characteristic distribution.
The sides and webs of the fingers, wrists, axillae, areolae, and genitalia are among the
common sites of involvement. Crusted scabies, a less common variant that primarily occurs
in the setting of reduced cellular immunity and is associated with a heavy mite burden, is
characterized by thick scale, crusts, and fissures. The diagnosis of scabies is confirmed
through the detection of scabies mites, eggs, or feces with microscopic examination.
The clinical features and diagnosis of scabies will be reviewed here. The management of
scabies is discussed separately. (See "Scabies: Management".)
EPIDEMIOLOGY
Scabies is a relatively common infestation that can affect individuals of any age and
socioeconomic status. The worldwide prevalence is estimated to be 200 million people, with
wide variation in prevalence among individual geographic regions [1]. A systematic review of
population-based studies from various regions of the world (excluding North America) found
prevalence estimates ranging from 0.2 to 71 percent, with the highest prevalences in the
Pacific region and Latin America [2]. Scabies is particularly common in resource-limited
regions.
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Crowded conditions increase risk for scabies infestation [3]. Epidemics can occur in
institutional settings, such as long-term care facilities and prisons [4].
LIFE CYCLE
S. scabiei var. hominis is a whitish-brown, eight-legged mite ( picture 1A-B). Female mites
are larger than male mites and measure approximately 0.4 x 0.3 mm [3]. After mating,
female mites burrow into the epidermis, a process facilitated by secretion of proteolytic
enzymes that cause keratinocyte damage [5]. Female mites continue to extend the burrow
and lay two to three eggs per day before dying after four to six weeks [3]. Larvae hatch in
three to four days and molt three times within the burrow to reach adulthood.
The mite burden in patients with classic scabies is generally low, limited to an average of 10
to 15 mites during an initial episode and approximately half as many with subsequent
infestations [6,7]. In contrast, patients with crusted scabies can have up to millions of mites
on the body.
In typical conditions (at room temperature and average humidity), mites can survive off a
host for 24 to 36 hours [8]. Survival times can be longer in colder conditions with high
relative humidity [8,9].
TRANSMISSION
Transmission of scabies usually occurs through direct and prolonged skin-to-skin contact, as
may occur among family members or sexual partners [10]. Casual skin contact is unlikely to
result in transmission. Transmission through fomites (eg, clothing, bedclothes, or other
objects) used by a person with classic scabies is uncommon; however, fomite transmission is
more likely to occur in the setting of crusted scabies due to a much higher parasite burden
[3,11]. (See 'Life cycle' above.)
True scabies infestation is not transmitted from animals to humans. The scabies mites
responsible for animal scabies (ie, sarcoptic mange) belong to distinct subspecies and
typically cannot reproduce in humans. Reactions to such mites are usually self-limited and
resolve if contact with the affected animal ceases [3,12].
CLINICAL MANIFESTATIONS
The major clinical variants of scabies are classic scabies and crusted scabies.
Classic scabies — The prominent clinical feature of classic scabies is pruritus. It is often
severe and usually worse at night. Pruritus results from a delayed-type hypersensitivity
reaction to the mite, mite feces, and mite eggs [6]. Symptoms typically begin three to six
weeks after primary infestation [13-15]. However, in previously infested patients, symptoms
usually begin within one to three days after infestation, presumably because of prior
sensitization [13,14,16].
Typical cutaneous findings are multiple small, erythematous papules, often excoriated
( picture 2A-G). Burrows may be visible as 2 to 15 mm, thin, gray, red, or brown,
serpiginous lines ( picture 3A-B). Burrows are a characteristic finding but often are not
visible due to excoriation or secondary infection. Miniature wheals, vesicles, pustules, and,
rarely, bullae also may be present.
The distribution of cutaneous findings usually involves more than one of the following areas;
rarely, scabies is localized to a single area [17,18] ( figure 1):
● Sides and webs of the fingers ( picture 2A, 2H-I)

● Flexor aspects of the wrists ( picture 2B-C, 2J)
● Extensor aspects of the elbows
● Anterior and posterior axillary folds ( picture 4)
● Periareolar skin (especially in women) ( picture 2E)
● Periumbilical skin
● Waist
● Male genitalia (scrotum, penile shaft, and glans) ( picture 2D, 2K)
● Extensor surface of the knees
● Lower buttocks and adjacent thighs ( picture 5)
● Lateral and posterior aspects of the feet ( picture 2F)
The back is relatively free of involvement, and the head is spared except in very young
children. Young children and infants often show heavy involvement of the palms and soles
and all aspects of the fingers ( picture 6A-C). Lesions in children are usually more
inflammatory than in adults and often are vesicular or bullous ( picture 7A-E).
Nodular scabies is a less common manifestation of classic scabies. Nodular scabies is

characterized by persistent, firm, erythematous, extremely pruritic, dome-shaped papules 5
or 6 mm in diameter. The groin, genitalia, buttocks, and axillary folds are the usual sites of
involvement ( picture 8A-C). The nodules may represent a hypersensitivity reaction to prior
or currently active scabies infestation [19,20].
Crusted scabies — Crusted scabies (also known as scabies crustosa, Norwegian scabies,
Boeck scabies, or keratotic scabies) can occur in the presence of conditions that compromise
cellular immunity, such as AIDS, human T cell lymphotropic virus type 1 (HTLV-1) infection,
leprosy, and lymphoma [21]. This variant may also occur in older adults and patients with
Down syndrome [22]. Crusted scabies may also accompany long-term use of topical
corticosteroids [23]. High numbers of scabies mites are present. (See "Fever and rash in
patients with HIV".)
Crusted scabies begins with poorly defined, erythematous patches that quickly develop
prominent scale ( picture 9A-G). Any skin area may be affected, but the scalp, hands, and
feet are particularly susceptible. If untreated, the disease usually spreads inexorably and may
eventually involve the entire integument. Scales become warty, especially over bony
prominences. Crusts and fissures appear. The lesions are malodorous. Nails are often
thickened, discolored, and dystrophic. Pruritus may be minimal or absent.
Laboratory abnormalities may include eosinophilia and increased immunoglobulin E (IgE)

levels [24]. (See "Eosinophil biology and causes of eosinophilia", section on 'Parasites and
other infections'.)
COMPLICATIONS
Secondary staphylococcal or streptococcal infections, including impetigo, ecthyma,

paronychia, and furunculosis, frequently complicate classic scabies. The fissures associated
with crusted scabies provide a portal of entry for bacteria. This may lead to sepsis in older
adults and immunocompromised patients [25]. Streptococcal infections may lead to
poststreptococcal glomerulonephritis or other complications [26]. Data from an in vitro study
suggest that a scabies mite complement inhibitor (SMSB4) may contribute to increased risk
for secondary streptococcal infections. (See "Poststreptococcal glomerulonephritis".)
Rarely, patients with scabies develop generalized urticaria. Occurrences of urticaria as the
initial manifestation of scabies have been reported [27,28].
HISTOPATHOLOGY
The histopathologic findings can vary based upon lesion morphology. Common histologic
findings include epidermal spongiosis and a mixed infiltrate in the dermis with eosinophils,
lymphocytes, and histiocytes. In crusted scabies, the stratum corneum is markedly
thickened.
Scabies, mites, eggs, or feces may be visualized if captured in the biopsy specimen and are
most likely to be visualized in patients with crusted scabies, given the high number of mites
present. Pink, pigtail-like structures may be present in the stratum corneum and may
represent egg fragments [29].
DIAGNOSIS
The diagnosis of scabies is confirmed through the detection of the scabies mite, eggs, or
fecal pellets (also known as "scybala") through microscopic examination. However, since
these findings are not always readily detected given the low number of mites in patients with
classic scabies and microscopic examination is not always feasible, a presumptive diagnosis
is sometimes made based upon a consistent history and physical examination [30,31].
Dermoscopy is a helpful adjunctive diagnostic tool. Skin biopsies are not usually necessary
and are reserved for difficult cases in which other disorders need to be excluded. (See
'Differential diagnosis' below.)
History and physical examination — The diagnosis of classic scabies should be suspected
in patients with one or more of the following [32,33]:
● Widespread itching that is worse at night, spares the head (except in infants and young
children), and seems to be out of proportion to visible changes in the skin
● A pruritic eruption with characteristic lesions and distribution ( figure 1)
● Other household members with similar symptoms
A diagnosis of crusted scabies should be suspected when the following features are present:
● Thick, crusted, fissured plaques

● Older adult or immunosuppressed patient
Burrows often are not evident on physical examination but, when seen, strongly support the
diagnosis ( picture 3A-B, 9F).
Examination for mites — The definitive method to confirm diagnosis of scabies is a scabies
preparation. Scabies preparations are used to detect mites, mite eggs, or mite fecal pellets.
Dermoscopic examination can identify sites of scabies mites or burrows and can facilitate
placement of the scraping. Because of the low mite burden in classic scabies, negative
results do not exclude the diagnosis [11,34,35]. (See 'Scabies preparation' below and
'Dermoscopy' below.)
Scabies preparation — Performance of a skin scraping involves the sampling and

microscopic examination of the epidermis from sites that may harbor scabies mites. In
adults, the areas most likely to yield mites are between the fingers, sides of hands, flexural
wrists, elbows, axillae, groin, breasts, and feet. Sites on the palms, soles, or torso may offer
the highest yield in infants and young children. The sensitivity of scabies preparation ranges
from 46 to 90 percent; the specificity is 100 percent [36].
Scrapings should be performed on skin lesions in multiple sites; burrows or erythematous

papules are ideal. Anesthesia is not necessary. A blade (typically a number 15 blade) is used
to vigorously scrape across the surface of the lesion sufficiently to remove a portion of the
epidermis without inducing significant bleeding. A 3 mm disposable curette is an alternative
tool that may be helpful for performing a scraping on children [37]. Prior to scraping, a small
amount of mineral oil is usually applied to the site or the blade to aid in removal of mites,
scale, and debris.
The specimen should be applied to a glass slide. Additional mineral oil can be added prior to
placement of the coverslip. Application of potassium hydroxide (KOH) to the slide may be
helpful for examination of specimens from suspected crusted scabies; the KOH will dissolve
excess keratotic debris [36]. The clinician then examines the specimen for scabies mites,
eggs, or feces ( picture 1A-D). In crusted scabies, large numbers of mites and eggs may be
seen [22].
Alternatively, a scabies preparation can be performed using a piece of transparent tape with
a strong adhesive (eg, clear packing tape) rather than a blade [34,38]. This procedure is
called "the adhesive tape test." The tape is firmly applied to a skin lesion and then is rapidly
pulled off. After applying the tape to a glass slide, the clinician utilizes a microscope to
examine the tape for mites and eggs. An advantage of the adhesive tape test is the lack of
need for specialized equipment other than a microscope. The procedure may also be useful
in children who cannot tolerate skin scrapings.
Dermoscopy — Dermoscopy (examination of the skin surface with a handheld

dermatoscope to allow visualization of specific structures related to the epidermis, dermal-
epidermal junction, and papillary dermis) may be a useful tool in scabies [34,35]. The test can
be used to visualize mites and burrows in vivo and to guide the placement of confirmatory
skin scrapings [39]. A disadvantage of dermoscopy as a sole diagnostic test is lower
specificity compared with scabies preparation [36]. In addition, mites are frequently difficult
or impossible to detect via dermoscopy in patients with highly pigmented skin [34]. (See
"Overview of dermoscopy".)
The characteristic finding on dermoscopic examination is a dark, triangular shape that

represents the head of the mite within a burrow ("delta wing" sign) ( picture 10A-B). In
addition, burrows are more easily visualized with dermoscopy. A noodle-like pattern
representing aggregates of burrows has been described in crusted scabies [40].
Laboratory tests — Blood tests are generally not indicated for the diagnosis of scabies.
However, eosinophilia has been reported, particularly in crusted scabies, and investigation of
the cause of persistent eosinophilia has led to the diagnosis of scabies in challenging cases
[24,41]. (See 'Crusted scabies' above and "Eosinophil biology and causes of eosinophilia",
section on 'Parasites and other infections'.)
DIFFERENTIAL DIAGNOSIS
Lesions of classic scabies are often excoriated, obscuring their appearance. The differential
diagnosis is broad, and scabies can appear similar to common pruritic disorders, such as
atopic dermatitis, contact dermatitis, nummular eczema, and arthropod bites. (See "Atopic
dermatitis (eczema): Pathogenesis, clinical manifestations, and diagnosis", section on
'Clinical manifestations' and "Clinical features and diagnosis of allergic contact dermatitis"
and "Nummular eczema" and "Insect and other arthropod bites".)
Close attention to the patient's history (eg, pruritus in close contacts) and physical
examination (eg, distribution and morphology of lesions) is helpful for differentiating scabies
from these diagnoses. Dermoscopic examination can be used to identify features that
strongly suggest scabies. When positive, a scabies preparation confirms a scabies diagnosis.
(See 'Clinical manifestations' above and 'Diagnosis' above.)
Less common disorders in the differential diagnosis of classic scabies include dermatitis
herpetiformis and bullous pemphigoid:
● Dermatitis herpetiformis – Dermatitis herpetiformis is an autoimmune blistering

disorder associated with gluten sensitivity. Classic clinical manifestations include
intensely pruritic, inflammatory papules and vesicles with predilection for the forearms,
knees, scalp, and buttocks ( picture 11A-B). The diagnosis is confirmed through skin
biopsy and direct immunofluorescence microscopy demonstrating granular deposits of
immunoglobulin A in the dermal papillae. (See "Dermatitis herpetiformis".)
● Bullous pemphigoid – Bullous pemphigoid is an autoimmune blistering disorder that

usually occurs in older adults. A prodromic phase characterized by pruritic, eczematous,
papular, or urticaria-like skin lesions can precede the development of the classic
features of tense bullae on an erythematous, urticarial, or noninflammatory base
( picture 12). The diagnosis is confirmed through a skin biopsy and direct
immunofluorescence microscopy demonstrating linear deposition of immunoglobulin
G and/or C3 along the basement membrane zone. (See "Clinical features and diagnosis
of bullous pemphigoid and mucous membrane pemphigoid".)
In particular, the clinical differential diagnosis of classic scabies in infants should include
acropustulosis of infancy and Langerhans cell histiocytosis:
● Infantile acropustulosis (acropustulosis of infancy) – Infantile acropustulosis is a

benign, recurrent, vesiculopustular eruption characterized by pruritic vesiculopustules
( picture 13). The extremities, especially the palms and soles, are the primary sites of
involvement. Diagnosis is based upon the clinical features and the absence of
additional findings suggestive of scabies. Burrows are absent, and a scabies
preparation will be negative. (See "Vesicular, pustular, and bullous lesions in the
newborn and infant", section on 'Infantile acropustulosis'.)
● Langerhans cell histiocytosis – Langerhans cell histiocytosis is a rare histiocytic

disorder that can have associated skin manifestations. Infants or young children may
present with red-orange or yellow-brown, scaly papules, erosions, or petechiae, often
on the groin, intertriginous skin, and scalp ( picture 14A-B). A skin biopsy is necessary
to confirm the diagnosis. (See "Clinical manifestations, pathologic features, and
diagnosis of Langerhans cell histiocytosis".)
The differential diagnosis of crusted scabies includes other disorders characterized by

hyperkeratotic patches or plaques, including psoriasis, seborrheic dermatitis, Darier disease
( picture 15A-B), and palmoplantar keratoderma. A scabies preparation differentiates
crusted scabies from these disorders. (See "Psoriasis: Epidemiology, clinical manifestations,
and diagnosis" and "Seborrheic dermatitis in adolescents and adults" and "Cradle cap and
seborrheic dermatitis in infants" and "Darier disease" and "The genodermatoses: An
overview", section on 'Palmoplantar keratodermas'.)
Occasional patients with pruritus secondary to other causes strongly believe that they have
scabies in the absence of true infestation. The clinical evaluation aids in distinguishing these
patients from patients with scabies. The clinical evaluation can also help to identify the
subgroup of patients who may have delusional parasitosis, a psychiatric disorder
characterized by a fixed, false belief of infection with parasites or other organisms. (See
"Pruritus: Etiology and patient evaluation", section on 'Evaluation' and "Delusional
infestation: Epidemiology, clinical presentation, assessment, and diagnosis".)
INFORMATION FOR PATIENTS
UpToDate offers two types of patient education materials, "The Basics" and "Beyond the
Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th
grade reading level, and they answer the four or five key questions a patient might have
about a given condition. These articles are best for patients who want a general overview
and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are
longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th
grade reading level and are best for patients who want in-depth information and are
comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to
print or e-mail these topics to your patients. (You can also locate patient education articles
on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)
● Basics topics (see "Patient education: Scabies (The Basics)")
● Beyond the Basics topics (see "Patient education: Scabies (Beyond the Basics)")
SOCIETY GUIDELINE LINKS
Links to society and government-sponsored guidelines from selected countries and regions
around the world are provided separately. (See "Society guideline links: Scabies".)
SUMMARY AND RECOMMENDATIONS
● Epidemiology – Scabies is a common infestation of the skin caused by Sarcoptes scabiei

( picture 1A-B). Scabies can affect individuals of any age and socioeconomic status.
Crowded conditions increase risk for scabies infestation. (See 'Epidemiology' above.)
● Scabies mites – Scabies mites typically cannot be seen with the naked eye. The size of
the larger female mite is approximately 0.4 x 0.3 mm. Female scabies mites create
burrows in the skin where they lay two to three eggs per day. (See 'Life cycle' above.)
● Clinical variants – The two major clinical variants of scabies are classic scabies and
crusted scabies. Classic scabies, the most common presentation, is associated with a
relatively low mite burden (approximately 10 to 15 mites on the body). Crusted scabies
usually occurs in older adults or immunocompromised individuals and is associated
with a much higher mite burden (up to millions of mites on the body). (See 'Life cycle'
above and 'Clinical manifestations' above.)
● Transmission – Transmission of scabies usually occurs through direct and prolonged

skin-to-skin contact, as may occur among family members or sexual partners. Casual
skin contact is unlikely to lead to transmission. Transmission via fomites is uncommon
in classic scabies but is more likely to occur in crusted scabies. (See 'Transmission'
above.)
● Clinical manifestations:
• Classic scabies – The characteristic clinical findings of classic scabies are intense
pruritus and multiple small, erythematous papules that are often excoriated
( picture 2A-G). Burrows, which appear as 2 to 15 mm, thin, serpiginous lines, may
be visible ( picture 3A-B). The fingers, wrists, elbows, axillae, areolae, periumbilical
skin, waist, male genitalia, knees, buttocks, and feet are common sites of
involvement ( figure 1). The head is usually spared except in very young children.
Heavy involvement of the palms, soles, and fingers is common in very young
children ( picture 6A-C). Larger papules (nodular scabies) are a less common
manifestation ( picture 8A-C). (See 'Classic scabies' above.)
• Crusted scabies – Crusted scabies typically manifests as poorly defined,

erythematous patches that develop prominent scale, crusts, and fissures
( picture 9A-G). Nail dystrophy is common. Pruritus may be minimal or absent.
(See 'Crusted scabies' above.)
● Diagnosis – A diagnosis of scabies may be strongly suspected based upon the patient
history and physical examination. The diagnosis is confirmed through detection of
scabies mites, eggs, or feces through microscopic examination (scabies preparation)
( picture 1A-D). A negative scabies preparation does not exclude the diagnosis.
Dermoscopic examination is a helpful adjunctive diagnostic tool ( picture 10A-B). (See
'Diagnosis' above.)
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Topic 4038 Version 28.0
GRAPHICS
Sarcoptes scabiei and eggs
Courtesy of John T Crissey, MD.
Graphic 79567 Version 3.0
Sarcoptes scabiei
Reproduced with permission from: www.visualdx.com. Copyright VisualDx. All rights reserved.
Scabies
Multiple interdigital papules.
Scabies
Multiple small papules on the ventral wrist.
Scabies
Multiple erythematous papules on the ventral wrist.
Scabies male genitalia
Scabies. Pruritic papules and nodules are present on the penis and scrotum.
Reproduced with permission from: Goodheart HP. Goodheart's Photoguide of Common Skin Disorders, 2nd ed, Lippincott
Williams & Wilkins, Philadelphia 2003. Copyright © 2003 Lippincott Williams & Wilkins.
Scabies
Multiple excoriated papules on the breast.
Scabies
Multiple papules on the foot.
Scabies
Numerous erythematous papules and excoriations on the arms and chest in a patient with extensive
skin involvement.
Scabetic burrow
Erythematous, linear scabetic burrow.
Scabies
Erythematous papules and multiple small burrows with overlying scale are present in the interdigital
space in this patient with acquired immunodeficiency syndrome (AIDS).
Scabies distribution
Scabies usually involves the sides and webs of the fingers, the flexor aspects of the wrists, the
extensor aspects of the elbows, anterior and posterior axillary folds, the skin immediately adjacent to
the nipples (especially in females), the periumbilical areas, waist, male genitalia (scrotum, penile shaft,
and glans), the extensor surface of the knees, the lower half of the buttocks and adjacent thighs, and
the lateral and posterior aspects of the feet. The back is relatively free of involvement; the head is
spared except in very young children.
Interdigital lesions of scabies
The essential lesion is a small, erythematous, nondescript papule.
Courtesy of John T Crissey, MD.
Scabies
Erythematous, excoriated papules are present on the hand of this patient with scabies.
Scabies
Scabies. Lesions are present on the flexor wrists.
Williams & Wilkins, Philadelphia 2003. Copyright ©2003 Lippincott Williams & Wilkins.
Scabies lesions in the axilla of a child
Reproduced with permission from: George A Datto, III, MD.
Scabies
Erythematous papules on the distal penis.
Scabies
Erythematous papules and nodules on the buttocks.
Scabies
Erythematous papules, vesicles, and pustules are present on the sole of the foot of this infant.
Scabies
Erythematous and hyperpigmented papules and crusts on the foot of a child with scabies.
Scabies, infant
The rash of scabies may be more diffuse in infants, spreading to the trunk and scalp in addition to the
extremities.
Reproduced with permission from: Fleisher GR, Ludwig S, Baskin MN. Atlas of Pediatric Emergency Medicine, Lippincott
Scabies
Multiple erythematous papules are present on the wrist of this infant.
Scabies
Erythematous papules and vesicles are present in the axilla of this infant.
Scabies, infant
extremities.
Scabies, infant
Scabies – This infant has papular and vesicular lesions on the trunk.
Reproduced with permission from: Goodheart HP. Goodheart's Photoguide of Common Skin Disorders, 2 nd ed, Lippincott
Scabies, infant
extremities.
Scabies axilla
Erythematous papules are present in the axilla of this patient with scabies.
Scabies
Nodular scabies on the penis.
Scabies
Papules and small nodules on the scrotum.
Crusted scabies
Hyperkeratotic, fissured plaque on the hand.
Crusted scabies
Hyperkeratotic, fissured plaque on the extremity.
Crusted scabies
Hyperkeratotic plaque on the scalp.
Crusted scabies
Marked hyperkeratosis on the foot.
Crusted scabies
Crusted scabies in a patient with acquired immunodeficiency syndrome (AIDS). The lesions resemble
solar keratoses.
Crusted scabies
Crusted scabies in a patient with AIDS. Note the crusted papules and the white, linear burrows.
Crusted scabies
Verrucous plaques on the hands and thickened, dystrophic nails. The lesions are teeming with mites.
Williams & Wilkins, Philadelphia 2003. Copyright © 2003 Lippincott Williams & Wilkins.
Sarcoptes scabiei and eggs
Scabies skin scraping
Several oval eggs and multiple small, brown feces are present in this specimen. A mite is visible in the
upper right corner of the image.
Scabies mite appearance on dermoscopy
The dark triangular shape in this image represents the head of the scabies mite.
Reproduced with permission from: DermNet NZ. For more information, visit http://dermnetnz.org/. Copyright © 2011.
Scabies mite appearance on dermoscopy
The dark triangular shape in this image represents the head of the scabies mite. This mite is located
at the end of a burrow.
Reproduced with permission from: DermNet NZ. For more information, visit http://dermnetnz.org/. Copyright © 2011.
Dermatitis herpetiformis
Multiple excoriated papules and crusts are present near the elbow.
Dermatitis herpetiformis
Multiple excoriated, erythematous papules are present on the buttocks.
Eczematous lesions in bullous pemphigoid
Eczematous and erythematous, urticarial plaques with eroded blisters and excoriations on posterior
trunk and extremity skin.
Acropustulosis of infancy
Multiple small pustules are present on the foot.
Reproduced with permission from www.visualdx.com. Copyright VisualDx. All rights reserved.
Langerhans cell histiocytosis
Yellow-brown and erythematous papules, erosions, and crusts are present on this infant with
Langerhans cell histiocytosis.
Langerhans cell histiocytosis
Yellow-pink papules with scale are present in the diaper area of this infant with Langerhans cell
histiocytosis.
Darier disease
Greasy, discrete, flat-topped, yellow-brown papules on the palm.
Darier disease
Multiple yellow-brown, hyperkeratotic papules are present on the chest.

Scabies - Epidemiology, Clinical Features, and Diagnosis

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Scabies - Epidemiology, Clinical Features, and Diagnosis

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21/2/24, 19:48 Scabies: Epidemiology, clinical features, and diagnosis - UpToDate

Official reprint from UpToDate®

Scabies: Epidemiology, clinical features, and diagnosis

Literature review current through: Jan 2024.

● Sides and webs of the fingers ( picture 2A, 2H-I)

Nodular scabies is a less common manifestation of classic scabies. Nodular scabies is

Laboratory abnormalities may include eosinophilia and increased immunoglobulin E (IgE)

Secondary staphylococcal or streptococcal infections, including impetigo, ecthyma,

● A pruritic eruption with characteristic lesions and distribution ( figure 1)

● Other household members with similar symptoms

● Thick, crusted, fissured plaques

Scabies preparation — Performance of a skin scraping involves the sampling and

Scrapings should be performed on skin lesions in multiple sites; burrows or erythematous

Dermoscopy — Dermoscopy (examination of the skin surface with a handheld

The characteristic finding on dermoscopic examination is a dark, triangular shape that

● Dermatitis herpetiformis – Dermatitis herpetiformis is an autoimmune blistering

● Bullous pemphigoid – Bullous pemphigoid is an autoimmune blistering disorder that

● Infantile acropustulosis (acropustulosis of infancy) – Infantile acropustulosis is a

● Langerhans cell histiocytosis – Langerhans cell histiocytosis is a rare histiocytic

The differential diagnosis of crusted scabies includes other disorders characterized by

INFORMATION FOR PATIENTS

● Basics topics (see "Patient education: Scabies (The Basics)")

SOCIETY GUIDELINE LINKS

SUMMARY AND RECOMMENDATIONS

● Epidemiology – Scabies is a common infestation of the skin caused by Sarcoptes scabiei

● Transmission – Transmission of scabies usually occurs through direct and prolonged

• Crusted scabies – Crusted scabies typically manifests as poorly defined,

Use of UpToDate is subject to the Terms of Use.

5. Fimiani M, Mazzatenta C, Alessandrini C, et al. The behaviour of Sarcoptes scabiei var.

12. www.cdc.gov/parasites/scabies/index.html (Accessed on August 11, 2017).

33. Heukelbach J, Wilcke T, Winter B, Feldmeier H. Epidemiology and morbidity of scabies

Sarcoptes scabiei and eggs

Courtesy of John T Crissey, MD.

Graphic 79567 Version 3.0

Graphic 114524 Version 3.0

Multiple interdigital papules.

Graphic 114527 Version 3.0

Multiple small papules on the ventral wrist.

Graphic 114528 Version 3.0

Multiple erythematous papules on the ventral wrist.

Graphic 114529 Version 3.0

Scabies male genitalia

Graphic 65362 Version 5.0

Multiple excoriated papules on the breast.

Graphic 114531 Version 3.0

Multiple papules on the foot.

Graphic 114530 Version 3.0

Graphic 114532 Version 4.0

Erythematous, linear scabetic burrow.

Graphic 53715 Version 9.0

Graphic 62395 Version 8.0

Graphic 71374 Version 4.0

Interdigital lesions of scabies

The essential lesion is a small, erythematous, nondescript papule.

Courtesy of John T Crissey, MD.

Graphic 51161 Version 2.0

Graphic 51125 Version 8.0

Scabies. Lesions are present on the flexor wrists.

Graphic 50111 Version 3.0

Scabies lesions in the axilla of a child

Reproduced with permission from: George A Datto, III, MD.

Graphic 73679 Version 2.0