Snapshot A 21-year-old male college student presents to the health clinic complaining of intense itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. Several other students have presented with similar problems over the last couple of weeks. Introduction Superficial skin infection caused by arthropod Sarcoptes scabiei (mite) Severe itching at night Too small to be seen by naked eye Pathognomonic sign burrows linear markings in skin due to mites’ movements Risk factors close contacts with scabies Presentation Symptoms hallmark feature itching worse at night Physical exam adults burrows, especially in between finger web spaces erythematous, inflamed pustules and papules linear markings in skin with some scale commonly on wrist, finger webs, axillae, chest, umbilicus, and genital area children generalized pruritic rash scalp may also be involved immunocompromised commonly on scalp and head extremely high mite burden "crusty" secondary bacterial infection Evaluation Diagnosis based on clinical exam and history Diagnosis confirmed with simple office procedure skin scraping with mineral oil prep can see mites under microscopy Differential Chiggers Bedbugs live in old mattresses painless bites with pruritic and purpuric macules treatment is symptomatic (triamcinolone) Contact dermatitis Treatment Topical permethrin apply to entire body for 8-10 hours repeat in one week If extensive involvement (immunocompromised individuals) oral ivermectin Sterilize laundry wash/dry all clothing with high heat or throw away Prevention, and Complications Prevention avoid those with known scabies treat all known contacts sterilize laundry Complications secondary bacterial infections Prognosis Very good with treatment