From the Guidelines
An infected scabies rash is characterized by small, raised, pimple-like bumps or blisters on the skin that have become secondarily infected with bacteria, often presenting with increased inflammation, swelling, warmth, and purulent discharge or crusting. The rash typically starts as intensely itchy, red bumps or lines (burrows) between fingers, on wrists, elbows, armpits, waist, buttocks, genitals, and around the nipples. When infection develops, these areas become more inflamed, swollen, warm to touch, and may ooze pus or develop yellow crusting. The skin might appear redder than a typical scabies rash, and the itching often becomes more severe, particularly at night. The infection occurs when scratching breaks the skin, allowing bacteria (commonly Staphylococcus or Streptococcus) to enter.
In severe cases, such as crusted scabies, the condition can be more aggressive and difficult to treat, often requiring combination therapy with a topical scabicide, such as 5% topical permethrin cream, and oral ivermectin treatment, as recommended in the 2015 guidelines for sexually transmitted diseases treatment 1.
- Key characteristics of an infected scabies rash include:
- Increased inflammation and swelling
- Warmth and redness of the affected skin
- Purulent discharge or yellow crusting
- Severe itching, particularly at night
- Treatment of infected scabies rash involves addressing both the scabies mites and the bacterial infection, and may require simultaneous treatment of household members and close contacts to prevent reinfestation, as well as washing of bedding and clothing in hot water to kill any mites. The most effective treatment approach for infected scabies rash is a combination of topical permethrin 5% cream and oral antibiotics, such as cephalexin or clindamycin, with consideration of oral ivermectin treatment in severe cases, as supported by the guidelines for sexually transmitted diseases treatment 1.
From the Research
Infected Scabies Rash Description
- The infected scabies rash is characterized by an erythematous papular eruption, serpiginous burrows, and intense pruritus 2.
- The rash typically appears at sites of predilection, including:
- Webs of the fingers
- Volar wrists
- Lateral aspects of fingers
- Extensor surfaces of elbows and knees
- Waist
- Navel
- Abdomen
- Buttocks
- Groins
- Genitals 2.
- The scabies mite burrows into the skin, producing a papular rash and severe itch at typical sites of predilection 3.
- Thread-like papules (burrows), new, intense pruritus, and dermatitis guide the suspected diagnosis which is confirmed by the microscopic or dermatoscopic demonstration of scabies mites 4.
- Classic scabies is characterized by an erythematous papular eruption, serpiginous burrows, and intense pruritus, while other clinical variants include crusted scabies, nodular scabies, and bullous scabies 2.
Diagnosis and Confirmation
- A clinical diagnosis of classic scabies can be made on the basis of the history and clinical findings 2.
- Finding the mite, ova, or fecal pellets on microscopic examination of scrapings taken from skin lesions confirms the diagnosis of scabies infestation 2.
- Microscopic or dermatoscopic demonstration of scabies mites is used to confirm the suspected diagnosis 4.