Scabies on Palms and Soles
Yes, scabies can occur on the palms and soles, particularly in infants, young children, and increasingly in older children and adults with severe or prolonged infestations in tropical climates.
Age-Related Distribution Patterns
Infants and Young Children
- Palms and soles are commonly involved in infants and very young children, along with the scalp, face, and neck—this represents a classic distribution pattern distinct from adults 1, 2, 3.
- The eruption in neonates and infants is typically generalized, including the head, neck, face, palms, and soles, with an early tendency to pustule formation 4.
- Infants should be treated on the scalp, temple, forehead, and down to the soles of the feet with permethrin cream 2.
Adults (Traditional Teaching)
- Adults traditionally manifest lesions primarily on interdigital web spaces, flexor wrists, dorsal feet, axillae, elbows, waist, buttocks, and genitalia—with palms and soles typically spared 5.
- The scalp rarely becomes infested in adults, though the hairline, neck, temple, and forehead may be affected in geriatric patients 2.
Emerging Pattern: Palms in Older Children and Adults
Recent evidence demonstrates a changing scenario where palms (and soles) are increasingly involved in older children and adults, particularly under specific circumstances 5:
- If patients are left untreated for long periods in hot tropical climates, scabies may produce severe infestation with involvement of palms in older children and adults 5.
- A 2021 case series documented 25 older children and adult patients with scabies including palm involvement, suggesting this should be acknowledged as a potential body site whose involvement warrants early and aggressive treatment 5.
Clinical Implications
Diagnosis
- The presence of lesions on palms and soles should not exclude scabies in any age group, though it is more characteristic of infants and young children 3, 4.
- In older patients with palm involvement, consider severe or prolonged infestation requiring more aggressive treatment 5.
Treatment Coverage
- Permethrin 5% cream must be applied from the head to the soles of the feet in all patients, ensuring complete coverage including palms 2.
- The standard application instruction "from neck down to soles" inherently includes palms and soles in the treatment field 1, 2.
Key Pitfall to Avoid
Do not assume palm and sole sparing in scabies based solely on patient age—while this is the traditional pattern in adults, severe or prolonged infestations can involve these sites at any age, and infants/young children routinely have palm and sole involvement 5, 3, 4.