History: This elderly lady has been treated once already for scabies but it has recurred. She shows typical burrows on the sides of her fingers and multiple burrows and excoriations around the areolae and nipple. These are well shown under the dermatoscope where the mite is the dark tip of the burrow. This lady was treated with oral Ivermectin with a single dose and given topical permethrin cream all over on two further occassions. Her family were also treated topically.
Itch can persist in treated scabies for days or weeks. This can be due to persistent mite hypersensitivity or induced eczema. It should be treated with a weak topical corticosteroid cream and not further antiscabetic therapy which paradoxically may just make things worse.