Scalp Scabies in an Older Woman: A Case Report

Scabies is typically characterized by pruritic lesions. In immunocompetent adults, these most commonly affect the interdigital spaces, wrists, and trunk, while sparing the face and scalp. However, the incidence of atypical presentations involving the scalp may be under-reported, particularly in older adults and institutionalized patients. We report a case of a 90-year-old woman with a prolonged history of scalp pruritus. Unrecognized scalp involvement contributed to the therapeutic failure of scabies treatment. Upon examination, scabies with scalp involvement was confirmed using dermoscopy and skin scraping. The patient was treated with oral ivermectin. Topical permethrin was also applied thoroughly from head-to-toe, including the scalp. This case highlights the critical importance of a comprehensive head-to-toe examination, the use of dermoscopy for diagnostic accuracy, and complete topical treatment, particularly in high-risk populations.