Guidelines classic scabies: in children < 15kg, pregnant or breastfeeding women
Updated on january 2024
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The diagnosis of classic is made during the patient's examination by the doctor.
The main symptom is the presence of chronic, almost constant itching (pruritus), which intensifies at night. The presence of itching in family members and in the environment can guide the diagnosis.
Scabies, known as "clean people's scabies," is often challenging to diagnose due to the rarity of lesions. It should be considered in the presence of persistent diffuse chronic itching.
The most common skin lesions are not specific as they are related to scratching or the body's inflammatory immune reaction to the presence of the sarcoptes in the skin: they include linear streaks, scratches, small crusts, red patches, and dryness of the skin.
The specific lesions are not always present and should be carefully sought:
The burrows: Lesions a few millimeters in the form of sinuous lines, due to the parasite's path in the horny layer of the epidermis.
The pearl vesicles: Small elevations or tiny "blisters," the size of a pinhead, located at the end of the burrow (where the parasite resides).
Scabies Burrows
It is at the level of the vesicles and burrows that the parasite can most often be observed, using a dermatoscope placed on the skin. The sarcoptes are invisible to the naked eye, but under the dermatoscope, they appear as a very small black or dark brown triangle, resembling a hang glider or a Chinese hat, characteristic, and confirming the diagnosis (this hang glider corresponds to the anterior part of the parasite).
However, a negative search does not eliminate the diagnosis, especially when the number of parasites in the skin is low.
Scabies BurrowsHang glider, anterior part of the parasite
The other specific lesions are scabious nodules, red or purplish nodular lesions, raised, in domes, of several millimeters, or even centimeters, which are frequent especially in the scrotum in men. They are of immuno-allergic origin.
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