Scabies surrepticious: disguising as tinea

Dear Editor, Scabies surrepticious refers to atypical or nonclassical presentation of scabies that can mimic other dermatological conditions, leading to diagnostic challenges. A 30-year-old female, presented with red raised itchy annular lesions on the left hand, gluteal, and periumbilical areas of 1 month duration. Itching was more at night. There were no history of similar complaints in family. She was managed with topical as well as systemic antifungals for a fortnight, but there was no relief in the symptoms. Dermatological examination revealed involvement of left hand, periumbilical region, and gluteal area in the form of multiple scaly annular plaques with central clearing (Fig. 1a–c). Potassium hydroxide mount of scales failed to reveal any fungal hyphae (Fig. 1d). Mineral oil preparations on skin scraping from affected sites unraveled scabies mite (Fig. 2a, b). The patient was diagnosed as a case of scabies surrepticious masquerading as tinea corporis. She was counseled and treated with 5% permethrin cream. She was followed-up after completion of treatment with full resolution of skin lesions in a couple of weeks.Figure 1: (a, b, and c): Scaly papules and plaques on the dorsum of the left hand; buttocks, periumbilical, and gluteal areas. (d): Potassium hydroxide (KOH) mount of skin scraping showing no fungal hyphae (KOH; ×40).Figure 2: (a, b): Sarcoptes scabiei mite in skin scraping (Mineral oil preparation; ×10, 40).The term “surrepticious” is derived from the Latin word surripere, meaning “to seize secretly” (sub-=under, rapere = to seize), reflecting the stealthy and deceptive nature of these presentations. Unlike classical scabies, which typically presents with, involvement of web spaces and flexural areas in form of severely itchy papules and papulo-vesicles, scabies surrepticious may manifest as urticarial plaques, pustules, nodules, bullous eruptions, or even lesions mimicking autoimmune diseases [1–3]. In such cases, the disease may be misdiagnosed as bullous pemphigoid, lupus erythematosus, prurigo nodularis, or perforating dermatoses. A high index of suspicion, thorough clinical history, and confirmatory tools such as dermoscopy, skin scrapings, or histopathology are essential for accurate diagnosis [2,4]. Early recognition of this ‘hidden‘ form of infestation is crucial, not only for effective management but also for preventing community outbreaks. The case is presented to bring forward this rare presentation of scabies as dermatophytosis. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given the consent for images and other clinical information to be reported in the journal. The patient understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. “Data availability statement: data is available upon request.”