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Because the clinical presentation of scabies and the appearance of lesions are variable, we chose not to devote several lines of text to all the variations on the clinical lesions that we saw. The large majority of patients had papular lesions, often with an eczematous component or visible burrows, occurring most commonly in typical anatomic areas (eg, finger webs, genitals, extensor surfaces of the elbows). Dr Clayman apparently failed to note that the diagnosis was confirmed by microscopic demonstration of mites, ova, or fecal droppings in 81% of the patients. Moreover, the clinical responses to permethrin and lindane were virtually identical in the subjects with and without microscopic confirmation (as shown in Table 2 of our article), supporting our belief that the clinical diagnosis was accurate in the unconfirmed cases.
Handsfield HH. Did They See Mites?-Reply. Arch Dermatol. 1990;126(7):967. doi:10.1001/archderm.1990.01670310130026