Symptoms

If the patient has never been infested with scabies, symptoms will be likely to occur after 4 to 6 weeks. However, previous history of scabies will be manifest signs and symptoms within several days. Patients should know that they do not become immune with scabies infestation.

Characteristic Signs and Symptoms of Scabies

The primary lesion, the burrow, is a gray-brown threadlike lesion a few millimeters in length which is usually difficult to see. The presence of the mite causes severe itching, especially at night, and inflammation which results in the formation of papules, vesicles, excoriations, and crusting.

The classic symptoms of scabies include lesions that resemble wavy, brownish, threadlike lines occurring most frequently noted on the hands (especially the interdigital webs), and flexor surface of the wrists, posterior inner surface of the elbows, anterior axillary folds, nipples in the female, belt line, gluteal creases, wrists, shoulder blades, elbow, waist, axilla, popliteal spaces, buttocks, groin, and male genitalia. The head and neck are rarely involved. Pruritus may be severe, especially at night. Scabies could also manifest pimple like irritations, skin burrows on infected area. Body sores are likely to occur which is caused by vigorous scratching secondary severe itching. Secondary infections with excoriations and pustules may result from scratching.

When secondarily infected the skin may feel hot and burning but this is a minor discomfort experienced by the infected individual. When large areas are involved and secondary infection is severe possible manifestations include the following: fever, headache, and body malaise. Secondary dermatitis (inflammation of the skin) is likely to happen.

Atypical Signs and Symptoms

Infected Blacks or those with dark skin

• Scabies is noticeable as nodules (granulomatous type)

• Infected Infants

• Involve area include palms, face, soles, and scalp, especially the posterior auricular fold.

• Infected Elderly Patients

• Severe and intense pruritus is manifested with minimal skin findings

• Immunocompromised Patients,

• Adults: Extensive nonpruritic scaling, mostly on the soles and palm

• Children (mostly in scalp area).

Diagnosis is made through history taking, results of physical assessment and findings, especially on inspected burrows on infected area which is confirmed by itch mite, fecal pellets, or ova on microscopic inspection of burrow scrapings. Sample scrapings should be kept by placing mineral oil, immersion oil, or glycerol over the infected skin burrow or skin papule (to prevent spread of mites and material during scraping), which is then unroofed with the edge of a scalpel. The material is then placed on a slide and enclosed with a cover slip. Take note: Potassium hydroxide must be avoided since it liquefies fecal pellets.