{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:11:17Z","timestamp":1788948677746,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Scabies, caused by Sarcoptes scabiei, is a recognised neglected disease of rising global burden, and increasing resistance to first-line scabicides is making treatment failure more frequent. No dermoscopic marker of cure has been validated for monitoring treatment response, so a reliable marker of active infestation is crucial. The tunnel window sign (TWS)\u2014rounded perforations along the burrow, visible under polarised dermoscopy and ultraviolet-induced fluorescence dermoscopy (UVFD)\u2014is a recently introduced candidate. We aimed to determine whether TWS represents a dermoscopic marker of active scabies infestation by evaluating its specificity, treatment dynamics and diagnostic performance under polarised dermoscopy and UVFD. Methods: In this single-centre observational study conducted in 2026, 33 patients with active scabies (Cohort 1; 106 burrows in 30 permethrin\u2013ivermectin-adherent and 11 in 3 non-adherent) and 30 controls with excoriated pruritic dermatoses (Cohort 2; 150 lesions) were examined. All Cohort 1 patients were re-evaluated every 4 weeks until resolution. Paired polarised\/UVFD images were re-scored by four raters (three blinded). Results: TWS was undetectable in all 30 controls with pruritic dermatoses and in all 30 post-treatment adherent patients (0\/30 and 0\/30, respectively). It resolved with effective treatment (undetectable from week 4; McNemar p &lt; 0.0001), preceding pruritus resolution, and persisted in non-adherent patients until retreatment. At the burrow level, UVFD detected TWS more sensitively than polarised dermoscopy (68\/106 vs. 60\/106; p = 0.0078; adjusted OR 1.38, 95% CI 1.07\u20131.79). Inter-rater agreement was almost-perfect (Fleiss\u2019 \u03ba = 0.872). Conclusions: TWS behaves as a dermoscopic marker of active scabies infestation: it disappears after successful treatment, persists following treatment failure, and distinguishes active infestation from both post-treatment skin and non-scabietic pruritic dermatoses. UVFD improves its detection compared with polarised dermoscopy.<\/jats:p>","DOI":"10.3390\/jcm15186972","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:24:02Z","timestamp":1788945842000},"page":"6972","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Tunnel Window Sign Identifies Active Scabies Infestation: A Validation Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5955-1833","authenticated-orcid":false,"given":"Mateusz Krzysztof","family":"Mateuszczyk","sequence":"first","affiliation":[{"name":"University Centre of General Dermatology and Oncodermatology, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Pablo","family":"Moreno-Reolid","sequence":"additional","affiliation":[{"name":"Department of Applied Physics, University of Granada, 18071 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9622-1593","authenticated-orcid":false,"given":"Magdalena","family":"\u0141yko","sequence":"additional","affiliation":[{"name":"University Centre of General Dermatology and Oncodermatology, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Joanna","family":"Maj","sequence":"additional","affiliation":[{"name":"University Centre of General Dermatology and Oncodermatology, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0140-6736(19)31136-5","article-title":"The public health control of scabies: Priorities for research and action","volume":"394","author":"Engelman","year":"2019","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e760","DOI":"10.1111\/jdv.18335","article-title":"Scabies revisited in the COVID-19 era","volume":"36","author":"Trave","year":"2022","journal-title":"J. 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