What are the histologic features of scabies?

Updated: Oct 13, 2020
  • Author: Megan Barry, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

The histologic features of scabies are distinctive enough to suggest the diagnosis, although they are common to a variety of arthropod reactions. If a burrow is excised, mites, larvae, ova, and feces may be identified within the stratum corneum, as in the images below.

Scabies mite in the stratum corneum. Courtesy of W Scabies mite in the stratum corneum. Courtesy of William D. James, MD.
In crusted scabies, sections show multiple mites ( In crusted scabies, sections show multiple mites (arrows) within the hyperkeratotic stratum corneum. The epidermis is spongiotic (hematoxylin and eosin; original magnification, 100X).

A superficial and deep dermal infiltrate composed of lymphocytes, histiocytes, mast cells, and eosinophils is characteristic. Spongiosis and vesicle formation with exocytosis of eosinophils and occasional neutrophils are present, as in the image below. Biopsy of older lesions is nondiagnostic, demonstrating only excoriation and scale crusts.

In routine scabies, a single mite is seen. Eosinop In routine scabies, a single mite is seen. Eosinophilic spongiosis may be present (hematoxylin and eosin; original magnification, 400X).

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