4 Skin eruptions are characterized by inflammatory, pruritic papules at infested sites; and the pathognomonic linear-to-serpiginous intradermal burrows. 4 Scabietic burrows are 5 to 10 mm long, dotted with fecal lithes (pellets) or scybala, and terminate in raised papules that may rarely hide ovipositing females. 4 Non-specific secondary lesions occur commonly from scratching (self-inflicted excoriations and lichenification); secondary infection (impetigo); or side effects of topical treatments (eczematization). Ribociclib The diagnosis of

scabies is made predominantly by epidemiological considerations and clinical and microscopic observations. A clinical diagnosis may be confirmed by low power microscopic examination of a burrow skin scraping which may excavate a female mite, 0.2 to 0.5 mm in length, translucent

with brown legs, and too small to be seen without magnification. 4 Eggs (0.02–0.03 mm in diameter), smaller eggshell fragments, and fecal lithes may also be identified in microscopic specimens of burrow scrapings. 4 Newer diagnostic methods for scabies now under investigation include enhanced microscopy (epiluminescence microscopy and non-computed dermoscopy); immunological detection of specific scabies antibodies by enzyme-linked immunosorbent assay (ELISA); and molecular identification of scabies mite DNA by polymerase chain reaction (PCR). 4,7,8 Topical or oral scabicides selleck chemical should be used to treat all infested persons and their close personal contacts simultaneously, regardless of the presence of symptoms. 4 Currently, recommended treatment options for scabies are listed in Table 2. The most effective topical treatments for scabies are 5% permethrin cream, 10 to 25% benzoyl benzoate lotion, and 1% lindane cream or lotion. 9 The topical treatments for scabies may not be well accepted or tolerated by some patients for many reasons including severe burning and stinging (with benzyl benzoate and 5% permethrin) in cases of secondarily excoriated or eczematous infestations. In such cases, a single oral dose of ivermectin, BCKDHB 200 mcg/kg, may

offer a more acceptable and equally effective alternative. 10 Nevertheless, ivermectin is not ovicidal, and a second course of oral treatment at adult maturation time of 14 to 15 days is recommended. 10 Scabies and follicle mites are the only exclusively human ectoparasitic mites and do not transmit infectious diseases. Less serious than scabies are infestations with the two human follicle mites: (1) Demodex folliculorum, which inhabits hair follicles; and (2) Demodex brevis, which inhabits sebaceous glands. The follicle mites are diminutive (0.1–0.4 mm long), usually non-pathogenic saprophytes, that feed on sebum and exfoliated skin while lodged in hair follicles and sebaceous glands on the eyelids, nasolabial folds, nose, and ears. 1 Although controversial, follicle mites may also be pathogenic agents of chronic blepharitis.