The history of a rash affecting more than one person in ARC is so critical to accurate diagnosis that the general practitioner (GP) must be informed if there is more than one person with symptoms, even if that person is not under the care of that particular GP. A confident clinical diagnosis can be made if burrows are identified on the wrists, finger web spaces and/or sides and soles of feet. Scabies burrows are best seen under magnification (dermoscopy) through which burrows ending with tiny grey triangles (the mites) can be seen. Burrows can be difficult to identify if the skin has been scratched, is infected or if eczema is present6. Scabies hypersensitivity rash typically affects trunk and limbs especially forearms and waist. It is often polymorphic with scattered erythematous papules (red bumps), pustules and urticated plaques (hive-like). Folliculitis (pimples), impetigo (sores) and eczema (dry or blistered patches) are common in persistent cases. Longstanding infestation leads to clusters of larger nodules in armpits and groins. Residents with long standing skin conditions are not immune to scabies infestation; do not assume these residents are free of infestation. Review by a dermatologist is recommended if there is any doubt of the diagnosis, either directly or via the GP. Population Health units are available to give advice on the investigation and management of cases and contacts. They do not diagnose or prescribe treatment options. Pictorial support Classical Scabies Fig 2 - Classical Scabies in staff. Small Fig 1- Classical single scabies burrow excoriations on forearms and hands are typical of scabies in a staff member Fig 3 - Polymorphous rash - papules, hive-like Fig 4 Extensive burrows in classical scabies (late plaques, scratch marks in classical scabies diagnosis) Crusted Scabies Fig 4 - Thick crusting in Crusted Scabies Fig 5 - Numerous scaly burrows - Crusted Scabies Fig 6 (left) Dermoscopy view of burrows in – Crusted Scabies
The history of a rash affecting more than one person in ARC is so critical to accurate diagnosis that the general practitioner (GP) must be informed if there is more than one person with symptoms, even if that person is not under the care of that particular GP. A confident clinical diagnosis can be made if burrows are identified on the wrists, finger web spaces and/or sides and soles of feet. Scabies burrows are best seen under magnification (dermoscopy) through which burrows ending with tiny grey triangles (the mites) can be seen. Burrows can be difficult to identify if the skin has been scratched, is infected or if eczema is present6. Scabies hypersensitivity rash typically affects trunk and limbs especially forearms and waist. It is often polymorphic with scattered erythematous papules (red bumps), pustules and urticated plaques (hive-like). Folliculitis (pimples), impetigo (sores) and eczema (dry or blistered patches) are common in persistent cases. Longstanding infestation leads to clusters of larger nodules in armpits and groins. Residents with long standing skin conditions are not immune to scabies infestation; do not assume these residents are free of infestation. Review by a dermatologist is recommended if there is any doubt of the diagnosis, either directly or via the GP. Population Health units are available to give advice on the investigation and management of cases and contacts. They do not diagnose or prescribe treatment options. Pictorial support Classical Scabies Fig 1- Classical single scabies burrow Fig 2 - Classical Scabies in staff. Small excoriations on forearms and hands are typical of scabies in a staff member Fig 4 Extensive burrows in classical scabies (late diagnosis) Fig 3 - Polymorphous rash - papules, hive-like plaques, scratch marks in classical scabies Crusted Scabies Fig 4 - Thick crusting in Crusted Scabies Fig 5 - Numerous scaly burrows - Crusted Scabies Fig 6 – (left) Dermoscopy view of burrows in Crusted Scabies