Scabies – one more lesson learned

During the course an outbreak of scabies in a nursing home, singular was the case of an elderly woman whose scabietic eruption was limited to her right hand and forearm. She had suffered a cerebral hemorrhage, was left aphasic with right hemiplegia. Her non-paralyzed left hand, restricted with a protective glove to prevent the patient drawing on the tracheostomy cannula, was not affected byeruption. This is what makes this case unusual and informative: while symptoms of scabies are mediated through inflammatory and allergy- like reactions, the scabietic eruption may remain limited to the site of direct contact with the source, dissimilar to hypersensitivity reactions. Scabies is an infestation of the skin by the mite Sarcoptes scabiei resulting in an intensely pruritic eruption with a characteristic distribution pattern. The disease is usually transmitted by direct skin-to-skin contact, with higher risk on prolonged contact. The symptoms are mediated through inflammatory and allergy-like reactions that result in severely pruritic rashes involving the wrists, elbows, back, buttocks, external genitalia, and the webbing between the fingers. The pathology results from sensitization of the host to the mites and to their excretions. For this reason,