Dermatology ruled out atopic dermatitis and reclassified the diagnosis as scabies due to the distribution of lesions , excoriations , and associated pruritus .

Scabies is a highly contagious ectoparasitic infestation by Sarcoptes scabiei mites . Scabies mites are arthropods that do not fly or jump. Scabies are spread by prolonged skin-to-skin contact. Rarely they can also be spread through shared clothing, towels, and linens [1]. Scabies affects people of all ages, races, and socioeconomic levels worldwide, with an estimated incidence of 300 million cases per year [1–4]. Scabies is considered a neglected skin disease by the World Health Organization due to its endemic nature in developing countries, its high economic burden, its association with poverty and its relative neglect by the scientific and healthcare communities [5]. Risk factors making people especially susceptible to mite infestation are immunocompromised status, homelessness, poverty, poor nutritional status, dementia, and living in conditions with overcrowding and poor hygiene [3]. It has also been associated with hospital and nursing home outbreaks [2, 3].

Scabies mites spend their entire life cycle in the epidermis [1, 2]. Adult female mites burrow into the stratum corneum layer of the skin, and lay eggs that typically hatch after 10 days. After a 4–6 week incubation period, hosts experience a hypersensitivity reaction to the mites, their saliva, and excretions [2]. Between 10 and 50 mites are thought to typically infect a host at any time [2–4]. Thousands of mites may be present in immunocompromised hosts, representative of a more severe form of the disease called crusted or Norwegian scabies. This variant is more difficult to treat and can lead to bacterial sepsis [1].