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Scabies / Itch Mite

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Topic updated on 09/09/17 4:42pm

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


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