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Updated: Mar 9, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
[Scabies of the nail unit in an infant]
A Finon1, G Desoubeaux2, M Nadal1
1Université François-Rabelais de Tours, 37000 Tours, France; Service de dermatologie, unité de dermatologie pédiatrique, CHRU de Tours, 37044 Tours cedex 9, France.
Insights
Infant scabies can recur, sometimes presenting with nail lesions. Subungual Sarcoptes scabiei in infants may lead to reinfestation, highlighting the need for defined treatment protocols.
Area of Science:
- Dermatology
- Parasitology
- Pediatrics
Background:
- Management guidelines for infant scabies are lacking.
- Recurrence of scabies is frequent in infants.
- This case highlights unusual presentations of scabies in infants.
Observation:
- A 7-month-old infant presented with thickened toenails and subungual hyperkeratosis.
- The infant had a history of classic scabies treated with topical esdepallethrin.
- Microscopic examination confirmed Sarcoptes scabiei larvae and debris in nail scrapings.
Findings:
- The patient exhibited subungual hyperkeratosis and ungual lesions.
- Fungal infections were ruled out by laboratory tests.
- The subungual and ungual locations of Sarcoptes scabiei were identified.
Implications:
- Subungual and ungual Sarcoptes scabiei in infants may serve as a reservoir for reinfestation.
- Effective treatment strategies for ungual scabies in infants require further definition.
- Current treatment involves nail avulsion and topical/oral antiscabies agents.
Background:
There are no guidelines regarding the management of scabies in infants and recurrence is common at this age. We report the case of an infant with subungual hyperkeratosis and ungual lesions subsequent to classic scabies.
Patients And Methods:
A 7-month-girl, treated 6 weeks earlier with esdepallethrin for scabies, consulted for acquired lesions on 3 toe nails. These nails were thickened and displayed subungual hyperkeratosis. Physical examination of the skin, the finger nails and mucous membranes was otherwise normal. Fungal analyses were negative, but direct microscopic examination revealed numerous larvae of Sarcoptes scabiei as well as ovular debris. The child was treated with urea 40% to obtain chemical avulsion of the nails, and with topical esdepallethrin and a quarter tablet of ivermectin orally; there was no follow-up of the child.
Discussion:
Ungual scabies has already been reported in crusted scabies and very rarely in classic scabies. Subungual and ungual locations of S. scabiei may constitute a source of reinfestation with scabies in infants. Treatment is not well defined and currently involves chemical avulsion of the nails and the application of topical antiscabies treatment.
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