Atopic Dermatitis vs Scabies
Atopic Dermatitis and Scabies are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Atopic Dermatitis vs Scabies at a glance
- Atopic Dermatitis: Chronic relapsing pruritic inflammatory dermatosis driven by skin barrier dysfunction and Th2 immune skewing; part of the atopic march.
- Scabies: Intensely pruritic infestation by Sarcoptes scabiei mite — burrows in web spaces and intensely itchy nocturnal rash; household contacts affected.
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Side-by-side comparison
| Feature | Atopic Dermatitis | Scabies |
|---|---|---|
| At a glance | Chronic relapsing pruritic inflammatory dermatosis driven by skin barrier dysfunction and Th2 immune skewing; part of the atopic march. | Intensely pruritic infestation by Sarcoptes scabiei mite — burrows in web spaces and intensely itchy nocturnal rash; household contacts affected. |
| Classic presentation | Flexural eczematous patches with lichenification in a child or adolescent with personal/family atopy.; Intense pruritus — required feature; often worse at night, disrupts sleep; Chronic relapsing course with flares and remissions; Dry skin (xerosis) between flares; Infants (0-2 yrs): erythematous, weeping, crusted patches on cheeks,… | Burrows in finger web spaces, flexor wrists, genitalia; intense nocturnal pruritus; multiple affected family members.; Intense generalized pruritus, worse at night, disrupting sleep; Pruritus in close contacts/household members; Onset 4-6 weeks after primary exposure (sensitization period); 1-3 days on reinfestation; Crusted scabies:… |
| Workup / key labs | Hanifin and Rajka criteria (3 major + 3 minor) or AAD simplified criteria. Essential features: pruritus + eczematous dermatitis in age-typical distribution + chronic/relapsing course.; Clinical diagnosis — no required labs; Serum total IgE often elevated; allergen-specific IgE or skin-prick testing only if clear allergic trigger… | IACS 2020 consensus: confirmed (mite/eggs/scybala visualized), clinical (burrows + classic distribution + 1 history feature), or suspected (typical lesions + history).; Skin scraping with mineral oil from burrow or papule, examined under microscopy: mites, eggs, or fecal pellets (scybala) — sensitivity only 30-50%, so negative scraping… |
| Imaging | Not indicated | Not indicated |
| First-line treatment | Skin barrier repair: emollient/moisturizer (ceramide-containing, petrolatum-based) applied liberally ≥2x/day and immediately after bathing ('soak and seal'); Lukewarm short baths/showers with non-soap cleanser (e.g., syndet); pat dry; Topical corticosteroid potency tailored to severity and site — hydrocortisone 1-2.5% (low; face, folds,… | Topical permethrin 5% cream — apply from neck down (include scalp/face in infants and elderly) overnight (8-14 hours), wash off in morning; REPEAT in 7 days (kills newly hatched larvae); first-line for most patients ≥2 months old; Oral ivermectin 200 mcg/kg PO on day 0 and day 7-14 — first-line alternative; preferred for institutional… |
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