What is the classic feature of scabies?

• A. Intensely pruritic papules and burrows in the web spaces and wrists
• B. Nonpruritic trunk-only rash
• C. Erythema migrans
• D. Vesicular lesions confined to the palms

Answer: (A)

Scabies is defined by intense itching together with characteristic skin changes produced by the mite tunneling under the skin. The most telling feature is the presence of burrows—thin, serpiginous tracks—along with itchy papules in the areas where the skin is thin and accessible to the mite, most classically between the fingers and on the wrists. This combination—severe nocturnal pruritus and visible burrows in the web spaces and around the wrists—captures the typical presentation and distribution, making it the best match for diagnosing scabies.

Other patterns don’t fit scabies as well: a nonpruritic trunk-only rash would not align with the hallmark itch; erythema migrans points to Lyme disease; vesicular lesions confined to the palms are not the standard distribution for adult scabies (palmar vesicles can occur in other conditions or in infants, but they’re not the classic picture).