[Persisting itching? Consider scabies]

Scabies is a common skin condition, which is accompanied by severe itching and a high degree of contagiousness. Rapid diagnosis and adequate treatment for the patient and his contacts is therefore important. Recognizing scabies is not always easy. Patients may present with atypical skin lesions. Persistent itching, more intense at night, and itching in relatives can then lead to the clinical (probable) diagnosis. Demonstration of the mite and/or eggs in the skin can confirm the diagnosis, either by dermatoscopy or direct microscopy of skin scrapings. Treatment consists of applying permethrin cream and/or taking ivermectin tablets. Although resistance to these agents has been suggested, treatment failure is mainly caused by failure to properly implement the treatment recommendations by the patient and/or his or her contacts. We present three patients with scabies in which the diagnosis and treatment could have been performed better.