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Chapter 17: Scabies

KEY POINTS

  • Scabies presents with a papular and vesicular morphology on all skin types that can vary most prominently in color.

  • In darker skin, it can appear brown to violaceous in contrast to pink to skin colored in lighter skin.

  • Darker skin can also have significant background hyperpigmentation that can be part of the active disease or postinflammatory in nature.

  • In crusted scabies, the degree of hyperkeratosis can vary, and in darker skin, this may be extensive enough to mask any underlying erythema.

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FIGURE 17-1.

Diffuse pink papules and patches with overlying excoriations on the buttock of a middle-aged woman. (Reproduced with permission from Wolff K, Johnson RA, Saavedra AP, et al. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 8th ed. New York, NY: McGraw Hill; 2017, Figure 28-23.)

A patient with pink papules and patches with a few crusts spread across the buttock.
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FIGURE 17-2.

Diffuse dark-brown and skin-colored papules with areas of overlying scale and a background of hyperpigmentation on the trunk, buttocks, and posterior upper extremities. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 149-16. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows scabies rashes appear dark and pigmented along the lower back and waist. Dry white patches are also seen in patches.
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FIGURE 17-3.

Pink papules, vesicles, and burrows on a digit. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 149-11. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows burrows of scabies rashes visible in the lateral side of a finger.
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FIGURE 17-4.

Pink scaly crusting and resolving vesicles in the interdigital webspace. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 64-3.)

A patient with brown skin with dark Pink crusting, and grey to white scales in the interdigital web space.
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FIGURE 17-5.

Scattered scaly violaceous nodules with surrounding pink papules in the axilla and the anterior trunk of a young child. (Reproduced with permission from Prose NS, Kristal L. Weinberg’s Color Atlas of Pediatric Dermatology, 5th ed. New York, NY: McGraw Hill; 2017, Figure 8-17.)

A patient with brown skin with hyperpigmented purple to dark brown nodules and pink papules spread across the anterior trunk and axilla. The nodules are scaly with crusts.
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FIGURE 17-6.

Pink, brown, and violaceous papules and plaques scattered along the face, chest, and upper extremities of an African infant. Note the variation in the colors of the papules, ranging from pink to erythematous on the face to violaceous and dark brown on the trunk and extremities. (From Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 95-52. Reproduced with permission from Barbara Leppard.)

A patient with brown skin with hyperpigmented purple to dark brown plaques and mostly pink papules spread across the face, trunk and upper extremities. The papules are pink on the face and lateral hand. The papules on the trunk and extremities are dark brown and deep purplish. Some scaling is also found on the plaques on the trunk and extremities.
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FIGURE 17-7.

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