Abstract Body

BACKGROUND AND PURPOSE

Scabies is an infestation by the mite Sarcoptes scabiei hominis. It is a relatively common consultation in general practice. It affects all ages and socio-economical status. Diagnosis is usually clinical, but can sometimes be difficult. In these cases, confirmation by microscope or biopsy is possible but requires an infrastructure usually not available in a primary care center. Dermoscopy can be a more accessible additional tool.

METHODS

Case presentation: A 26-year-old patient went to the primary care physician due to itching in the flexor aspects of the wrists, sides of the fingers and waist with an eruption and erythematous papules on the wrists. Based on the history and physical examination a diagnosis of scabies was made. Hygienic measures and an application of permethrin cream 5% at night two consecutive weeks were recommended to the patient and her cohabitants. After a slight improvement, the patient consulted again 15 days later due to the reappearance of the symptoms. Are we facing a recurrence of the infestation or the persistence of disease-free scabies nodules? Could it be a disease other than scabies?

RESULTS

Dermoscopy showed the mite's head inside a burrow known as a "delta wing" sign. This confirmed the presence of an active parasite within the burrows. A case of resistance was suspected and a treatment with two oral doses of ivermectin was recommended.

CONCLUSIONS

Dermoscopy can be a useful, fast and accessible diagnostic tool helpful to identify unclear scabies cases by the general practitioner.