The face usually remains uninvolved in adults. Diagnosis requires demonstration of a burrow, which may be difficult to find because of scarcity or because it is obscured by scratch marks or secondary dermatitis. If no burrows are found on the fingers, wrists, and male genitalia, the entire skin surface should be examined. Once a suspected burrow is located, the diagnosis should be confirmed by microscopy of scrapings from its surface. Finding the mite, ova, or fecal pellets clinches the diagnosis.
Improvement is slow, despite rapid eradication of mites.
Lindane cream or lotion is mainly of historical interest because it is irritating and potentially neurotoxic and should be avoided in infants and small children. Re-treatment is rarely needed unless infection is reacquired. Nodular lesions may persist for 1 to 2 mo. Concomitant bacterial infections may require systemic antibiotics but often clear spontaneously when scabies is cured. Extensive cleaning or fumigating of clothing or bedding is unwarranted because the mite does not live long off the human body.