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Review articles1 and dermatology textbook presentations of scabies2 often contain no images of its dermoscopic features and, in fact, may omit mention of dermoscopy as an aid in diagnosis. Scabies often occurs in populations where performing traditional scabies preparations may be challenging. Dermoscopy’s utility in these settings is that it is non-invasive, painless, and highly diagnostic. Confirmation of this diagnosis is important because treatment is recommended for many individuals (many of whom may be asymptomatic); treatment failure is not uncommon (for example, as a result of incorrect use of medication, poor compliance, or re-infestation) and can lead to doubt about diagnosis if not firmly established initially; and post-scabetic itch is common and can lead to doubt about diagnosis. Additionally, because scabies may mimic a host of other dermatologic conditions, it is easily misdiagnosed if not confirmed. Patients (or parents) can be shown mites through the dermatoscope, via dermoscopic photographs of the mite on the camera’s LCD screen, or shown the ex vivo microscopic findings to assure “buy in” to the diagnosis to foster compliance with treatment.
Depicted are images of the dermoscopic features of scabies (figs 1–3). Figure 1 depicts a feature that I have not found previously reported, specifically “mini-triangle signs” in maturing scabies’ eggs.
Dermoscopy employs magnification and light in such a way as to render the skin surface translucent, allowing visualisation of patterns that are often not visible with traditional clinical inspection. Originally employed to improve the detection of melanoma, it has since been used in a plethora of dermatologic conditions. Digital dermoscopic photographs can be viewed and magnified immediately on camera or computer screens.
Argenziano et al first reported the dermoscopic “triangle sign”, which represents the “head” portion of the mite, and “the delta wing jet with contrail” sign, corresponding to the head of the mite and the trailing burrow.3 Confirmation of scabies by dermoscopy is less time consuming than traditional methods of identifying mites. At the minimum, dermoscopy enables the mites to be located, which allows traditional mineral oil scabies preparations to be targeted precisely.
Competing interests: None.
Patient consent: Patient/guardian consent was obtained for publication