Scabies

Scabies is a mite that burrows into the skin and is classically intensely pruritic especially at night making it difficult to sleep. Risk factors include immunocompromised patients, patients living in close quarters, recent hospitalizations, however the reality is ANYONE exposed can contract this. Its a clinical diagnosis, but you should NOT always expect to see the interdigital excoriations from burrows (is pathognomonic but only 10-20% have this) make sure you disrobe the patient and look for papules and tiny vesicles scaly for excoriations along the flexor surfaces (inter-digital areas, wrist, elbows, underarms) and dont forget to look around the umbilicus, nipples and perineal area. Norwegian scabies have crusted layers that can look anywhere from white/yellow in color to darker hues in darker pigmented people.