Isolated itching of the genitals

Area of Science:

• Dermatology
• Parasitology

Background:

• Scabies is a contagious skin infestation caused by the mite Sarcoptes scabiei.
• While typically generalized, localized scabies presentations are rare, often associated with immunocompromised individuals.

Observation:

• A 38-year-old male, recently returned from Ivory Coast, reported a 3-month history of intense scrotal pruritus.
• Clinical examination revealed scrotal nodules, a penile chancrous lesion, and excoriations, but a whole-body dermoscopy found no typical scabies burrows.
• Microscopic examination of peri-genital skin scrapings confirmed the presence of Sarcoptes scabiei.

Findings:

• The patient was diagnosed with localized scabies predominantly affecting the scrotum.
• Microscopic confirmation of Sarcoptes scabiei was achieved through skin scrapings.
• Treatment with oral Ivermectin, two doses administered two weeks apart, resulted in successful eradication of the infestation for the patient and his family.

Implications:

• This case underscores that localized scabies can occur in immunocompetent patients, challenging the typical association with immunosuppression.
• It highlights the importance of considering scabies in the differential diagnosis of pruritic genital lesions, even in the absence of widespread symptoms.
• Successful treatment with Ivermectin demonstrates its efficacy in managing scabies infestations, including rare localized forms.