Scabies may go unrecognized in the elderly unless the clinician has a high index of suspicion.
Risk factors in the elderly:
(1) nursing home resident
(2) chronic corticosteroid therapy, oral or topical
(3) poverty with poor hygiene
(4) decreased immunity
Barriers to diagnosis:
(1) dementia
(2) decreased level of consciousness
(3) bedridden with failure to examine back
(4) darkened room
(5) suboptimal care (an outbreak can occur even with optimum care)
Misdiagnosis:
(1) pruritus misdiagnosed as anxiety, delirium or due to senile skin changes
(2) skin lesions misidentified (bullous lesions misdiagnosed as bullous pemphygoid, other)
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Specialty: Infectious Diseases, Dermatology
