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Chronic epidemic rash
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Chronic epidemic rash

I work at a nursing home.  We have had an chronic outbreak of a rash.  It is scattered with single raised bumps with no pattern mostly on the arms (particularly upper), back and chest.  It itches like crazy and can be especially bad when in the shower.  It itches so bad it can keep you up at night.  Several of residents have been to the doctor and had skin scrapings for scabies but those are negative,  I have seen many pictures of scabies and it looks nothing like those and it doesn't concentrate in the areas that scabies does at all.  Each time this rash comes back, they decide to treat with scabies treatment.  But I think this rash eventually goes away on its own anyway.  I had a couple spots the last time and I didn't take the scabies treatment and it went away eventually.  The problem is, this is a chronic problem with no diagnosis that is leaving scars on people from scratching from the intense itching.  Any ideas what this could be??????
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Hi,

'Scabies is frequently misdiagnosed as intense pruritus (itching of healthy skin) before papular eruptions form. Upon initial pruritus the burrows appear as small, barely noticeable bumps on the hands and may be slightly shiny and dark in color rather than red. Initially the itching may not exactly correlate to the location of these bumps.

Generally diagnosis is made by finding burrows, which often may be difficult because they are scarce, because they are obscured by scratch marks, If burrows are not found in the primary areas known to be affected, the entire skin surface of the body should be examined.

The suspicious area can be rubbed with ink from a fountain pen or alternately a topical tetracycline solution which will glow under a special light. The surface is then wiped off with an alcohol pad; if the person is infected with scabies, the characteristic zigzag or S pattern of the burrow across the skin will appear.

When a suspected burrow is found, diagnosis may be confirmed by microscopy of surface scrapings, which are placed on a slide in glycerol, mineral oil or immersion in oil and covered with a coverslip. '

You could read more about this at the following links -

http://en.wikipedia.org/wiki/Scabies

and

http://www.cdc.gov/ncidod/dpd/parasites/scabies/factsht_scabies.htm

Let us know about how you are doing and if you have any other doubts.

Regards.

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