Chief Complaint: “I have been itching nonstop, especially at night.”

History of Present Illness:
A 30-year-old woman from a densely populated rural community presents to the clinic with intense itching and a red, bumpy rash on her hands, wrists, and between her fingers. The itching started about three weeks ago and has progressively worsened, particularly at night. She has also noticed small burrow-like tracks on her skin. Other family members, including her two children, have similar symptoms.

She reports no recent travel but mentions that she shares a small living space with extended family. Over-the-counter creams have provided little relief. She denies any fever or systemic symptoms.

Physical Examination:

• Excoriated papules and thin, wavy, grayish burrows on the interdigital spaces, wrists, and elbows
• Signs of secondary bacterial infection in some scratched areas
• No swollen lymph nodes or systemic involvement

Diagnosis:
The clinical presentation is consistent with scabies, a parasitic skin infection caused by Sarcoptes scabiei mites. The diagnosis is confirmed with a skin scraping, which reveals mites, eggs, and fecal pellets under microscopic examination.

Management Plan:

• Topical treatment: Permethrin 5% cream applied overnight and repeated in one week
• Oral treatment (if needed): Ivermectin for severe or widespread cases
• Household and contact precautions:
  • All close contacts should be treated simultaneously
  • Wash all clothing and bedding in hot water
  • Clean living areas thoroughly to prevent reinfestation

The patient is reassured that itching may persist for a few weeks after treatment but should gradually improve. Follow-up is scheduled to monitor treatment success and manage any complications.