LAUSR

To the Editor: Scabies has been increasing around the world recently. In our daily practice, a significant portion of our outpatients consists of scabies. Increasing cases in Turkey, Germany, Croatia, and many countries in the last 5 years have been reported and attention has been drawn to the outbreak of scabies.1–3 Diagnostic methods need to be developed and diversified in order to effectively combat these increasing cases. Detection of the parasite is the most valuable approach in terms of diagnosis and treatment follow-up. Although the diagnosis is usually easy with typical sites of involvement and anamnesis, additional diagnostic methods are needed. Microscopy and dermoscopy are among these methods. When looking at the cilia with dermoscopy, an image that corresponds to the mouth and front legs of the parasite, which is defined as the delta sign, can be detected. Depending on the position of the parasite, we can sometimes see a clear delta sign, but sometimes we can only see the reflection of the mite in the form of a brown spot instead of the delta sign. In addition, when the parasite is deeper, we may not see the delta sign. In this case, we may not be able to view the parasite dermoscopically. Sarkoptes scabie var hominis mite gives a bright reflex under ultraviolet (UV) light.4 With the introduction of UV dermoscopy, we have defined a diagnosticmethod that ismore specific than the delta sign andwill not leave the clinician in doubt. At this point, we would like to share a new sign that can help us with diagnosis: the ball sign. We used the recently introduced UV dermoscopy device to obtain this mark. The UV dermoscopy device is a combined dermoscopy device with both polarized dermoscopy and UV light features. When looking at the tunnel with UV mode in scabies patients, the contents of the tunnel and the mite itself give a bright reflex. In this way, skin appendages such as squam, whichmay prevent us from seeing the parasite, are excluded and only the parasite reflects. Except for the area that we see as the delta sign in the polarized dermoscope, we can see the entire parasite in the UV dermoscope, resembling a ball. In this way, we use a more effective imaging method during both diagnosis and treatment control. When the mite cannot be seen clearly under polarized mode in the suspicious area, we can switch to UV mode and make use of the mite’s reflex to clarify the diagnosis. While we can