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