Chronic pruritus due to atypical scabies: Dermatoscopic identification using the ‘Jet with a Trail’ sign

Scabies is a common parasitic dermatosis in tropical countries and a frequent cause of chronic pruritus. Atypical and steroid-modified presentations often obscure classical clinical features, leading to misdiagnosis and delayed treatment. Dermatoscopy has emerged as a rapid, non-invasive bedside diagnostic tool that enhances diagnostic accuracy by enabling direct visualisation of the mite within its burrow. 
We report a 23-year-old student teacher who presented with a four-month history of generalised pruritus, previously treated as dermatitis and superficial fungal infection without improvement. Clinical suspicion of scabies was confirmed dermatoscopically by identifying the characteristic “jet with a trail” sign. The patient responded well to topical permethrin therapy. This case highlights the value of dermatoscopy in diagnosing scabies in clinically ambiguous presentations and supports its routine use in endemic settings such as Sri Lanka.