A Case of Scabies Presenting as Chronic Urticaria

Scabies outbreaks are relatively common worldwide, particularly in communal living settings such as military barracks. The infestation is caused by the parasite Sarcoptes Scabiei and is easily treated once properly diagnosed. Classic symptoms include pruritus around the waist, wrists, and ankles.1 On physical examination, linear burrows visualized in finger web spaces is a typical finding.1 It is not uncommon, however, for scabies to present with a variety of other dermatologic manifestations, which can lead to a delayed or missed diagnosis. This case highlights a delayed diagnosis of scabies, initially presenting as urticaria in a 26-year-old active duty male living in military barracks where multiple previous outbreaks were identified. Providers should be aware of the oftentimes-elusive diagnosis of scabies and the many nonclassic dermatologic manifestations. A thorough skin examination with skin scrapings and examination of the finger web spaces should be considered in those with ambiguous skin rashes who are particularly at risk for scabies infection, such as military recruits, submariners, and other service members living in communal settings. Timely and accurate diagnosis and treatment is crucial to prevent reinfection and spread of scabies throughout these communal living settings.