Pinworms (Enterobius vermicularis) are the most common cause of perianal itching in the pediatric age group. Jillson challenged the com­mon belief that pinworms elicit pruritus and proposed that symptoms are an uneasy crawling sensation and not itching [25]. The diagnosis can be made by microscopically evaluating perianal skin samples collected on cellulose tape. It is imperative that other family members be evalu­ated so that they can be treated and recontamina­tion does not occur. The symptoms usually occur in the evening, when these 6-mm long parasites migrate to the perianal skin. Pinworm infesta­tion is generally treated with a single dose of mebendazole [26]. Scabies is a contagious skin infestation due to the mite Sarcoptes scabiei that can elicit severe pruritus. Although usually found on the nger webs or sides of the ngers, these lesions can often be identied in the peri­anal region. The diagnosis of scabies can be con­rmed by demonstrating the mite or its products, such as ova or feces, from scrapings prepared on a slide with one drop of 10% potassium hydrox­ide [27]. Lesions appear initially as vesicles as the mite burrows its way into the stratum cor­neum. Treatment consists of the application of an appropriate scabeticide such as Kwell R lotion (Reed & Carnrick, Jersey City, NJ). The parasite Pediculosis pubis (crab or louse) can often be found grasping the base of a hair shaft and is noted to produce macular steel-gray spots, especially on the thighs and chest. With careful examina­tion under magnication this parasite strikingly resembles a crab. Management requires the treat­ment of all infected family members, appropriate delousing of all fomites such as clothes, bedding and upholstery and showering with an appropri­ate pediculocide such as permethrin [28].