[A woman with a very itchy rash].

A 53-year-old woman with Down syndrome presented with progressive palmar hyperkeratosis, erythema, and pruritus, accompanied by widespread papules and nodules. Considering a recent institutional outbreak of scabies and dermoscopic findings of multiple burrows and mites (delta sign), a diagnosis of crusted scabies was made. Treatment with ivermectin, permethrin, and strict hygiene measures resulted in resolution.