We present a case of scabies diagnosed with LC-OCT with a video of the live scan across the volume of the scabietic burrow.

General dermatology, diagnosis, confocal microscopy, scabies, line-field optical coherence tomography

Dear Editor,

Diagnosis of infestation by Sarcoptes scabiei can fox even the experienced dermatologist, particularly in those patients lacking the more classical signs. Our diagnostic armamentarium can often be found lacking with many modalities having poor sensitivity (microscopy of skin scrapings = 56.3% and dermoscopy = 43.5%) [1]. Recent studies have demonstrated the use of line-field confocal optical coherence tomography (LC-OCT) as a non-invasive diagnostic alternative [2–5]. Here we present a case of recurrent scabies diagnosed with the assistance of LC-OCT and confirmed with microscopy to add to the body of literature supporting this modality for diagnosis.

Full skin examination of a 42-year-old female revealed a widespread, erythematous, papular eruption without specific features in the interdigital web spaces or on the volar aspects of the wrists. Dermatoscopic examination demonstrated a lesion suspicious for a scabietic burrow [Figure 1A], which was further interrogated using LC-OCT imaging [Figure 2] with the Damae Medical produced deepLive^TM device. Scrapings from the lesion were examined under light microscopy [Figure 1B]. The diagnosis of scabies was confirmed, and the patient was treated with a course of ivermectin and instructed on the use of permethrin 5% cream and household measures to ensure clearance of the infestation.

Figure 1 depicts the dermatoscopic image of the burrow [Figure 1A] and the microscopic confirmation of the mite [Figure 1B]. Figure 2 depicts frame from a live video scan through the horizontal and vertical axes of the LC-OCT imagery, matched with the position within the dermatoscopic image. We see the tortuous burrow through the epidermis containing an adult mite on the far left (300 µm wide and 150 µm from the side of the frame where the rest of the mite has been cut off). Two eggs are seen mid right and far right, measuring around 100 µm in diameter.

Figure 1. 

Dermatoscopic image (A) of scabies burrow and microscopic image (B) of scabies mite scraped from the lesion.

Figure 2. 

Line-field confocal optical coherence tomography images of scabies mite (*), burrow and eggs (white arrows) as vertical (A) and horizontal views (B) with corresponding dermatoscopic image (C).