RT Book, Section A1 Usatine, Richard P. A1 Mishra, Vineet A1 El-Arab, Kaley K. A2 Usatine, Richard P. A2 Smith, Mindy A. A2 Mayeaux, Jr., E.J. A2 Chumley, Heidi S. SR Print(0) ID 1164359872 T1 Scabies T2 The Color Atlas and Synopsis of Family Medicine, 3e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259862045 LK accessmedicine.mhmedical.com/content.aspx?aid=1164359872 RD 2024/03/28 AB A 17-year-old young man is seen with severe itching of his hands and feet. He has no lesions between his fingers and no one else in the family is itching. He has seen multiple clinicians in the past 5 months and has been given many types of topical steroids and antihistamines. The last clinician referred him for psychotherapy, thinking that this must be psychogenic. On close examination, there are multiple burrows on the hands (Figure 149-1). Dermatoscopy shows the typical pattern of a "jet plane with a contrail," clinching the diagnosis of scabies (Figure 149-2). The patient is treated with permethrin cream overnight and repeated in 7 days. At the following visit his itching is gone, and he is so thankful. This case demonstrates the importance of looking for burrows as the morphologic manifestation of the mite under the skin. Although it was nice to have a dermatoscope to confirm the diagnosis, this diagnosis could easily have been made clinically just by careful observation. Not every patient with scabies has lesions between the fingers and contacts at home with pruritus.