This is the first of several articles where things are not
quite what they seem to be. This looks like it is a red scaly rash. You might
consider psoriasis, eczema or perhaps a fungal infection as a cause of all this
scale. This patient had a past history of severe atopic eczema and had
regularly been treated with oral antibiotics and courses of oral steroids.
However every time her steroids were reduced the rash would flare and her itch
would become intolerable. The scale would persist. The diagnosis was made by
asking her partner, who came with her, if anyone else at home was itchy? He immediately volunteered that he also had
an itchy rash which on examination showed typical scabies burrows in the web
spaces, wrists and genitals. His partner had the rare variant crusted or
Norwegian scabies. Luckily there was no one else at home to become infected
because crusted scabies easily starts scabies epidemics. The patient was
treated with a single dose of Ivermectin repeated in a week with daily
applications of permethrin cream all over in between. Dermoscopy Made Simple
