Clinical Features

Scabies tends to be an extremely pruritic eruption, often disturbing sleep (except Norwegian scabies, which tends to have minimal associated pruritus). Ihe most common sites of involvement include the hands, feet, flexural surfaces of the elbows and knees, umbilicus, groin, and genitals. Facial involvement is usually seen only in infants. Ihe pathognomonic lesion, or burrow, is a fine erythematous linear or curved lesion with central scale ( Fig 2.4.2.-1). Burrows are most often visible in the web spaces of the fingers, the lateral aspects of the fingers, the volar surface of the wrists, the instep of the feet, and the shaft of the penis. Often, however, burrows are not present, especially in patients with excellent hygiene. Excoriations and pruritic papules may be the only visible cutaneous feature. Vesicles are often seen in infants and young children.

Visible Flexural Eczema

FIG. 242-1. Human scabies. Numerous scabetic burrows are visible near the axilla of this infant infested with scabies.

In Norwegian scabies (Fig.239-9), one develops thick, dirty-appearing hyperkeratosis on the hands and feet. The nails are often affected as well. Because of the large mite burden, this form of scabies is highly contagious.

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