Dermoscopic Visualization of Crawling Mites in Crusted Scabies

A 32-year-old female having history of disseminated discoid lupus erythematosus (DLE) on oral corticosteroids and hydroxychloroquine presented with generalized itching for 3 months. On cutaneous examination, multiple erythematous plaques with central atrophy and depigmentation covered with thick whitish scales were present over the face, ears, scalp, trunk, and extensor aspect of the upper limbs. Also, there were diffuse plaques with thick whitish scales and fissuring, along with multiple excoriated papules over bilateral finger web spaces, buttocks, genitalia, trunk, and extremities [Figure 1]. Video-dermoscopic examination by Dinolite edge (AM7515MZT) with 62X magnification under a polarized mode showed multiple crawling mites within yellowish-white scale crusts [Figure 2 and Video 1]. Wet mount of skin scrappings from crusted lesion revealed multiple eggs and mites. A diagnosis of crusted scabies was made, and the patient was treated with daily 5% permethrin lotion application till two consecutive wet mounts became negative, along with oral ivermectin 12 mg (on days 1, 2, 8, 9, and 15), antihistamines, and manual removal of thick scales and crusts.Figure 1: Erythematous plaques with central atrophy and depigmentation, covered with thick whitish scales over extensor of right arm and forearmFigure 2: Video-dermoscopic examination by Dinolite edge (AM7515MZT) with 62X magnification under a polarized mode showing multiple mites (black circle) and yellowish-white scale crusts {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_0jiqljsm"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} The dermoscopic signs diagnostic of scabies include “triangle sign”, “delta glider”, “delta wing jet”, “jet plane”, “spermatozoid appearance”, “jet with contrail appearance” or “jet liner with its trail”, “mini triangle sign”, “grey-edged line”, “wake sign”, and ovoid structures, which depict burrows, mites, eggs, and feces.[1] “Noodle pattern/millipede-like structure” in dermoscopy corresponding to numerous burrows is considered a characteristic dermoscopic sign in crusted scabies.[2] The use of dermoscopy for visualization of crawling mites has been rarely reported. Chen et al. and Yao et al. have reported similar findings in the past.[3,4] This finding is being reported because of ease of making diagnosis and its prognostic significance to monitor treatment in crusted scabies. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.