A handshake with a catch

THIS hand looks pretty innocuous, slightly red with a bit of scale. Perhaps it might be psoriasis or a hyperkeratotic eczema?

However, shake this hand at your peril. This is Norwegian or crusted scabies, and these scales are chock full of scabies mites. This is the most contagious form of scabies you will ever see. Cases like this end up causing epidemics of scabies if they are admitted into hospital or nursing homes undiagnosed.

This gentleman had three hospital stays for unrelated conditions prior to his skin condition being correctly diagnosed. It is best treated with ivermectin orally followed by six days of topical permethrin cream overnight.

In addition, steroid cream can treat the inevitable associated eczema from scratching.

For dermatoscopic images of the mites log into www.skinconsult.com.au