The dermatologist has an appointment with a 30-year-old man that complains of severely itching rashes that especially disturb him at night. The rashes developed 2 weeks ago, after he had returned from a travel. Objectively on the lateral surfaces of his fingers, hands, wrists, elbows, lower abdomen, genitals, and thighs there are paired papulovesicles, single pustules, and scratch marks. What disease can be suspected?

Answer options

1. Dermatitis
2. Shingles
3. Eczema
4. Pyoderma
5. Scabies

Explanation

The agent of Scabies is Sarcoptes scabies. The human itch mite, Sarcoptes scabies var. hominis, is a common cause of itching dermatosis, infesting ~300 million persons worldwide at any one time. Gravid female mites (~0.3mm in length) burrow superficially within the stratum corneum, depositing three or fewer eggs per day. Six-legged larvae mature to eight-legged nymphs and then to adults. Gravid adult females emerge to the surface of the skin about 8 days later and then (re)invade the skin of the same or another host. The itching and rash associated with scabies derive from a sensitization reaction to the mites and their secretions/excretions. A person’s initial infestation remains asymptomatic for up to 6 weeks before the onset of intense pruritus, but a reinfestation produces a hypersensitivity reaction without delay. Pruritus typically intensifies at night and after hot showers. Classic burrows are often difficult to find because they are few and may be obscured by excoriations. Burrows appear as dark wavy lines in the upper epidermis and are 3–15 mm long. Scabies, with typical scaling erythematous papules and few linear burrows. Groin, axillae, between fingers and toes, beneath breasts Harrison’s principles of internal medicine. –19th Edition. – Ectoparasite Infestations and Arthropod Injuries. – P. 2744. Approach to the Patient with a Skin Disorder. – P. 339. Skin Manifestations of Internal Disease. – P. 353