Establishing patient history is a useful first step in the diagnosis of scabies. A definitive scabies diagnosis requires the identification of mites, eggs, eggshell fragments, or feces in the skin. Adult female and her eggs in the top left burrow. Scabies lesions are characterized by well-defined intraepidermal vesicles

Primary Methods of Diagnosis:

1. Skin scrapings: Physician uses a #15 blade to scrape a burrow site. The scraping should be mounted with a drop of 10% potassium hydroxide or mineral oil and observed under a microscope. Since there are so few mites in the entire body, they are difficult to find. Accordingly, failing to identify a mite does not rule out a positive scabies diagnosis.

2. Skin biopsy: If skin scrapings are inconclusive, a biopsy can confirm the presence of scabies mites. However, mites may not be in the stratum corneum, in which case the histology would reveal a nonspecific, hypersensitivity reaction.

Differential diagnosis of scabies is not rare. The parasitic disease is commonly mistaken for:

1. Insect bites (they resemble scabies without the burrow marks)

2. Eczema variations, particularly atopic dermatitis

3. Impetigo

Scabietic burrow containing eggs with embryos Norwegian scabies: mites in all developmental stages are arranged in hierarchical tiers