The penis and scrotum in males and nipples in females are other areas that may be affected. Although the mite burrow itself is often described as a clinical sign and it may appear in classic cases, in the majority of cases the burrows are not evident. The most common location of mite burrows can be contrasted with the reactions of the various parts of the body to attack by Sarcoptes . The hands and wrists give comparatively less reaction as compared with the softer body parts. Eczematous changes are very common in infants and young children.
Children commonly have secondary bacterial infections with pustules, bullous impetigo, and ecthyma.
In the elderly a diminished inflammatory or sensitization response to the infestation is presumably due to the individual's diminished immune competence. Nevertheless, intense itching may be present. Patients who are bedridden or have limited mobility may have extensive involvement of the buttocks and back. Crusted scabies is a relatively rare, highly contagious infestation. Mites in these cases build up to high numbers, and patients shed large numbers of organisms via crusted debris.