Scabies is most often misdiagnosed as insect bites, psoriasis, eczema, and many more because of their similar signs and symptoms. Similar symptoms include small pimple-like marks or rashes on the skin, accompanied by an intense itching sensation. One may rarely spot these mites as microscopic white dots, crawling along the surface. To avoid any chance of misdiagnosis, one should test these symptoms definitively, which relies on identifying the mites, their feces, or their eggs. A drop of mineral oil is placed directly over the infected area and then scraped gently with a scalpel, careful not to draw blood. This sample is then pressed onto a slide and viewed under a microscope, under both high and low power. A person with a classic case of scabies might find a few eggs or even mites; however, those infected with crusted scabies will show several more in just a small area. The absence of eggs or mites found on the slide does not completely rule out the possibilities of a scabies infestation.

By applying a topical tetracycline cream to the skin, the mite’s burrows can be easily identified. After washing off the excess cream, the burrows themselves may still retain some of the tetracycline, which is especially visible under a Wood lamp. Another viable method is using a washable felt-tip marker to cover the infected area, and shortly after cleansing the area with some alcohol and cotton. Because the ink penetrates the stratum corneum, there will be traces of ink evident in the mite’s burrow sites. The final diagnosis should include evidence based on health history, microscopic examination of parasites, and physical examination of the burrow sites. Other tests or devices that you can use include a digital video dermatoscope, which is a hand-held device that magnifies up to 60 times. Doctors may also test for elevated levels of immunoglobulin and eosinophilia, which may be present in those infected with scabies.

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