From urticaria to mites: a diagnostic turnaround in atypical nodular scabies —a case report

BACKGROUND: Scabies is a contagious skin infestation caused by Sarcoptes scabiei var. hominis, presenting with a wide range of clinical manifestations. Nodular scabies is an uncommon variant that typically affects the genital region. When nodules appear in atypical locations, they may resemble other dermatoses and complicate diagnosis. CASE PRESENTATION: A 56-year-old woman presented with persistent, pruritic nodules on the chest, buttocks, and thighs that clinically resembled papular urticaria. She had previously been treated with topical corticosteroids and antihistamines without improvement, prompting a diagnostic biopsy. Histopathological examination confirmed the presence of Sarcoptes mites in the stratum corneum. The patient and her family were treated with 10% sulfur ointment applied once daily for three consecutive days per course, with two courses administered one week apart. The nodules gradually regressed after two courses, while pruritus and intermittent wheals persisted for four weeks and resolved completely within two months. CONCLUSION: The case emphasizes the need to consider atypical scabies in the differential diagnosis of persistent nodular eruptions occurring in uncommon anatomical sites. CLINICAL TRIAL NUMBER: Not applicable.