The scabies mite spreads by direct skin contact, commonly within families, between children, and between sexual partners. Intense itching, especially at night, usually starts from 1–8 weeks later. The rash most commonly affects hands, wrists, axillae, nipples and genitals; the head and neck are hardly ever involved except in infants. Secondary bacterial infection of excoriated skin is frequent. The diagnosis is confirmed by finding mites or their eggs at the end of thread-like linear tunnels (‘burrows’). Immunosuppression, including AIDS,1 can lead to massive infestation with extensive crusting of the skin (‘Norwegian’ scabies).
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