A 74-year-old Caucasian woman visited an outpatient clinic at a homeless shelter. Her chief concern was itching all over her body. Her chart revealed a history of chronic scabies and mental illness. She had been seen in the clinic on 4 separate occasions over a 2-year period for scabies. She claimed on this visit that she could not get rid of the scabies because people kept taking away her medication. She also stated she could see the creatures feed on her and move in and out of her skin.
The physical exam revealed that she was unwashed and disheveled. She had multiple excoriations on her extremities, hands, abdomen, back, and the nape of her neck (Figure 1).
FIGURE 1
Excoriations on the abdomen
FIGURE 2
Adult body lice and nymphs on clothing seams
