The classic lesion is a straight or S-shaped burrow. These are most easily identified in the finger webs and about the wrists.

A burrow is a tract created by a mite wandering through the scaly layer on the surface of the skin

Burrows are commonly seen in the finger webs

Scratching destroys the burrows. The mite can sometimes be seen at one end of the burrow. It appears as a tiny black dot. Experienced clinicians can lift the mite from the skin with a needle tip and place it on a glass slide. A mite is difficult to find in other areas. Many lesions especially on the abdomen appear as pinpoint papules or vesicles. Lesions are almost never found on the face and adults. Children can develop lesions on any site including the palms and soles.

Large inflamed burrows are commonly seen on the wrists in adults and children

Scabies involving the hand and webs

Institutionalized elderly patients, AIDS patients and those with Down syndrome can present with extensive redness, scaling, and crusting and secondary infection. Examination of the scrapings from these lesions shows numerous mites. This extensive form of the disease is called Norwegian scabies. It is highly infectious.

Norwegian scabies is a massive infestation of mites that produces extensive scaling and inflammation