Diagnostic Tests for Scabs

Diagnostic Test list for Scabs:

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Scabs includes:

• Examination of skin
  • Examine characteristics of the scabs. Are the scabs thin, delicate and friable; or are they thick and adherent
  • What colour are the scabs. Scabs that are yellow are formed from dried serum. Scabs that are green or yellow-green are formed from pus-like discharge. Scabs that are brown or dark red are formed from dried blood
  • Note the distribution of the skin affected - i.e. focal or diffuse (e.g. focal scabs may suggest fungal skin infection, scabies, contact dermatitis, skin tumor, nummular eczema or impetigo; diffuse rash may suggest psoriasis, eczema, dermatitis herpetiformis, pemphigus or tinea versicolor; blisters and scabs in shingles occur in a dermatomal distribution.
  • What areas of the body does it primarily involve i.e. Extremities, face, trunk? - will help determine the cause (e.g. extremities may suggest atopic dermatitis, tinea, psoriasis or insect bites; front of the knees include psoriasis and dermatitis herpetiformis).
  • Are the lesions all at the same stage of evolution - e.g. chicken pox is characterized by starting as papules (red raised spots), then change to blisters which then scab over. The three stages present together.
• Physical examination
  • Temperature - fever may suggest chicken pox, erythema.
  • Multiforme, eczema herpeticum, exfoliative dermatitis, severe allergic contact dermatitis from poison ivy, shingles, hand foot and mouth disease, first episode of herpes simplex
  • Complete physical examination - disease does not usually affect the skin in isolation.
• Blood tests
  • Full blood count
  • Blood cultures, if unwell and fever
  • Radioallergosorbent testing (RAST) - to test for specific allergens that may be triggering eczema ( 90% relevant if negative, but only 20% relevant if positive).
  • Ig E levels are increased with atopic dermatitis
  • Viral serology tests, if indicated
• Skin tests
  • Microscopic examination of scrapings of any skin burrows (to detect scabies mite) or skin rash (to rule out fungal infection)
  • Patch testing to detect skin allergies
  • Skin biopsy may be necessary
• Swab of any discharge - for bacteria or fungi.
• Viral culture, if suspect viral infection such as herpes simplex, herpes zoster (shingles), varicella zoster (chicken pox)

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