Editing Scabies (section)

== Signs and symptoms ==
[[File:Sites of scabies.png|thumb|upright=1.3|Commonly involved sites of rashes of scabies<ref name=cdc/>]]

The characteristic symptoms of a scabies infection include intense [[pruritus|itching]] and superficial burrows.<ref name=Ray2009 /> Because the host develops the symptoms as a reaction to the mites' presence over time, typically a delay of four to six weeks occurs between the onset of infestation and the onset of itching. Similarly, symptoms often persist for one to several weeks after successful eradication of the mites. As noted, those re-exposed to scabies after successful treatment may exhibit symptoms of the new infestation in a much shorter period—as little as one to four days.<ref name=Markell9 />

===Itching===
In the classic scenario, the itch is made worse by warmth and is usually experienced as being worse at night, possibly because distractions are fewer.<ref name=Ray2009 /> As a symptom, it is less common in the elderly.<ref name=Ray2009/>

===Rash===
The superficial burrows of scabies usually occur in the area of the finger webs, feet, ventral wrists, elbows, back, buttocks, and external genitals.<ref name=Ray2009/> Except in infants and the immunosuppressed, infection generally does not occur in the skin of the face or scalp. The burrows are created by the excavation of the adult mite in the [[epidermis (skin)|epidermis]].<ref name=Ray2009/>  [[Acropustulosis]], or blisters and pustules on the palms and soles of the feet, are characteristic symptoms of scabies in infants.<ref name="DermNet"/>

<gallery widths="200" heights="200">
File:Acarodermatitis Fuß.jpg|Scabies of the foot
File:Acarodermatitis Arm.jpg|Scabies of the arm
File:Acarodermatitis Hand.jpg|Scabies of the hand
</gallery>

In most people, the trails of the burrowing mites are linear or S-shaped tracks in the skin, often accompanied by rows of small, pimple-like mosquito or insect bites. Lesions are symmetrical and mainly affect the hands, wrists, axillae, thighs, buttocks, waist, soles of the feet, areola, and vulva in females, and penis and scrotum in males. The neck and above are usually not affected, except in cases of crusted scabies and infestations of infants, the elderly, and the immunocompromised.<ref name=DermNet>{{cite web | title=Scabies: Diagnosis and Treatment with Images | vauthors = Maguire JR |date=March 2022| publisher=DermNet | url=https://dermnetnz.org/topics/scabies}} With link to many images</ref> Symptoms typically appear two to six weeks after infestation for individuals never before exposed to scabies. For those having been previously exposed, the symptoms can appear within several days after infestation. However, symptoms may appear after several months or years.<ref name=Bouvresse-2010 />

=== Crusted scabies ===
[[File:Norwegian Scabies in Homeless AIDS Patient.jpg|thumb|Crusted scabies in a person with AIDS]]

The elderly, disabled, and people with [[immunodeficiency|impaired immune systems]], such as those with HIV/AIDS, cancer, or those on [[Immunosuppressive drug|immunosuppressive medications]], are susceptible to crusted scabies (also called Norwegian scabies).<ref name=Ray2009 /><ref name=Bouvresse-2010 /><ref name=pmid19580575>{{cite journal | vauthors = Hicks MI, Elston DM | title = Scabies | journal = Dermatologic Therapy | volume = 22 | issue = 4 | pages = 279–292 | year = 2009 | pmid = 19580575 | doi = 10.1111/j.1529-8019.2009.01243.x | s2cid = 221647574 | doi-access = free }}</ref> On those with weaker immune systems, the host becomes a more fertile breeding ground for the mites, which spread over the host's body, except the face. The mites in crusted scabies are not more virulent than in noncrusted scabies but are much more numerous, sometimes up to two million. People with crusted scabies exhibit scaly rashes, slight itching, and thick crusts of skin that contain large numbers of scabies mites. For this reason, persons with crusted scabies are more contagious to others than those with typical scabies.<ref name=CDC2010Epi/><ref name=CDC>{{cite web | url = http://www.dpd.cdc.gov/dpdx/HTML/Scabies.htm | title = DPDx – Scabies | work = Laboratory Identification of Parasites of Public Health Concern | publisher = CDC | url-status = live | archive-url = https://web.archive.org/web/20090220123307/http://dpd.cdc.gov/dpdx/html/scabies.htm | archive-date = 2009-02-20 }}</ref> Such areas make eradication of mites particularly difficult, as the crusts protect the mites from topical miticides/scabicides, necessitating prolonged treatment of these areas.{{citation needed|date=July 2020}}