Key Points

  • Scabies is a highly contagious infestation due to the skin mite, Sarcoptes scabiei.
  • Typical sites of infestation are: wrists, ankles, interdigital web spaces, umbilicus, intertriginous sites (axilla, inguinal folds), and genitalia. The face and scalp are usually spared.
  • Patients commonly report intense pruritus. However, affected patients with neurologic disease, immunocompromised status, infants, or elderly individuals may not report pruritus.
  • The diagnosis of scabies can be made by presence of mites, eggs, or mite feces (scyballa) in skin scrapings, and can be visualized by skin biopsy.
  • The mainstay of scabies treatment in the United States includes permethrin 5% cream (such as Elimite) applied overnight in combination with decontamination of potentially infested clothing, bedding, and linens. Treatment of infants and pregnant women is distinct, and many different therapies are utilized around the world.
  • All close contacts or household members of infested individuals should be treated at the same time as the patient.
  • Systemic anti-parasitic treatment, such as ivermectin (such as Stromectol), may be necessary in severe cases such as generalized, crusted scabies infestation.
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