While scabies infestation may resemble lice infestation, the characteristic distribution of lesions aids in the differential diagnosis. Scabies bites are usually concentrated about the web spaces of the hands and feet. In adults, the nipple in females and the penis in males are frequent sites of involvement. Scabies rarely occurs above the neck in adults, who should be treated from the neck down with topical medications (permethrin, lindane, crotamiton, or in pregnant women, 5% sulfur ointment). Reapplication may be considered 1 week after initial treatment. The characteristic burrow of the female mite, a jagged white line with a gray dot at the end and overlying vesicles, is pathognomonic, but it is often obscured by the effects of scratching and may resemble dermatitis. Pruritus may persist after treatment and should not be interpreted as a treatment failure; antipruritic medications are indicated for symptomatic relief. Antibiotics may be indicated for secondary infections.