A 86-year-old fully bedridden woman with dementia and chronic kidney disease presented with extensive, grey-yellowish hyperkeratotic plaques located on the palms, axillae, chest, and face that had occurred 3 months ago (Fig. 1). Moreover, a generalized rash with thickening of the skin and intense pruritus was present. Dematoscopy revealed several dense triangles suspicious for scabies mites head parts (called “delta wing jet sign”) (Fig. 2; arrow). A lesional skin biopsy as well as specimen obtained from scraping confirmed an infection with Sarcoptes scabiei (Fig. 3; arrow, Fig. 4). The patient was treated with a combination of oral ivermectin and topical permethrin, resulting in a complete clearance of all lesions. Crusted scabies, also called Norvegian scabies, is a rare and severe variant of scabies that most commonly affects elderly, immobile or immunosuppressed individuals. Crusted scabies is extremely infectious. Our patient had infected her relatives and several other housemates in her residential care home. Fig. 1 Clinical findings at first presentation. Grey-yellowish hyperkeratotic plaques located on the left palm. Fig. 2 Several dense triangles suspicious for scabies mites head parts (called “delta wing jet sign”) are present in dermatoscopy. Fig. 3 Sarcoptes scabiei in histopathology. Four mites are located in statum corneum. Fig. 4 Sarcoptes scabiei in light microscopy.