Case Study #1

R.H., a 26 year old woman comes to see you with

a seven week history of a rash which is worse on
her hands. It is extremely itchy, particularly at night,
and she is worried that she could give “something”
to her 4 year old son.
So What is Your Differential
Diagnosis?
 DIFFERENTIAL DIAGNOSIS
• Differential diagnosis- adverse cutaneous
drug interaction, atopic dermatitis, contact
dermatitis, eczema, uticaria, pityriasis
rosea, dermatitis herpetiformis, pediculosis
corporis/pubis, scabies, lichen planus,
delusions of parasitosis, metabolic pruritis.
 Diagnosis
• Scabies is an infestation of the skin with the
microscopic mite Sarcoptes scabei.
• Acquired through direct, prolonged, skin-to-
skin contact with an infected person (i.e.,
same household, sexual partner).
• Diagnosis of scabies is made by looking at
the burrows or rash.
• Skin scraping may be taken to look for mites,
eggs, or mite fecal matter to confirm the
diagnosis.
• Eosinophilia is also present in crusted
scabies.
 Signs and Symptoms
• Classic locations- the webbing between the fingers;
the skin folds on the wrist, elbow, or knee; the
penis, the breast, axillae, feet, buttocks.
• Pimple-like irritations, burrows or rash of the skin.
In light-skinned individuals, burrows have a whitish
color with occasional dark specks.
• Intense itching that usually spares the head and
neck, and is worse at night.
• Sores on the body caused by scratching (this can
lead to secondary infections by bacteria).
Penile Scabies