Scabies Incognito

Atypical appearance of scabies such as chronic excoriation and eczematization of the skin, is frequently found in patients with long-standing infestations. Cases of less impressive scabies are not easily diagnosed, especially when topical or systemic corticosteroids mask the typical itch and inflammation. These cases frequently occur in individuals with good hygiene and are referred as scabies incognito – a diagnosis that can be easily mistaken for other skin diseases. A fourteen-year-old male patient had been irregularly taking systemic corticosteroid for two months due to intermittent papular reaction and itching. Four weeks after treatment with anti-scabiotic therapy, the patient has no complaint of itch and no sign of new papular lesion suggesting that he had scabies all along. It is very important to make a correct diagnosis of scabies incognito because misdiagnosis is associated with serious consequences such as spreading and superinfection of the lesions; this can sometimes lead to life-threatening consequences.