A diagnosis of active infestation is confirmed only by finding mites, mite ova or faecal pellets (scybala). Mite burrows in the skin, the distribution of papular lesions and bilateral itch not affecting the head, chest or back are indicative but are not confirmation of an active infestation. Nodular lesions around the axillae, navel or on the penis or scrotum are pathognomonic, but may persist for months after cure.

Figure 37.1 a) Papules, pustules and impetaginisation in the vicinity of scabies burrows and b) excoriated rash and papules on the wrists in simple scabies

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