Lice and Scabies: Treatment Update

Karen Gunning, PharmD; Bernadette Kiraly, MD; Karly Pippitt, MD


Am Fam Physician. 2019;99(10):635-642. 

In This Article

Clinical Presentation

Persons with scabies typically present with intense, generalized pruritus that is worse at night. The face and neck are unaffected. The primary skin lesions are erythematous, pruritic papules, pustules, vesicles, and nodules. The pathognomonic finding is a burrow (Figure 4), which is not always evident. The lesions are most commonly found on the finger webs, wrist flexors, elbows, axillae, buttocks, genitalia, and breasts.[25,26] Nonspecific secondary skin findings may include excoriations, eczematization, and pyoderma. The characteristic distribution of lesions in adults with scabies is illustrated in Figure 5.[3] Infants may present with pustules on the palms and soles and vesicles or other lesions on the neck and face.[25,26]

Figure 4.

Erythematous papules and burrows typical of scabies.
Image used with permission from VisualDx.

Figure 5.

Characteristic distribution of lesions in adults with classic scabies. Burrows are more common on hands and wrists, whereas papular or nodular lesions are generally present elsewhere.
Reprinted with permission from Flinders DC, De Schweinitz P. Pediculosis and scabies. Am Fam Physician. 2004;69(2):345.