Crusted scabies, a rare variant of classical scabies, is a highly contagious condition in which the skin is infected with thousands to millions of mites. It can be defined as a generalized severe scabies infestation usually affecting immunocompromised patients. The diagnosis is becoming more relevant with the increasing use of immunosuppressive medications and the HIV epidemic. To date, more than 200 cases have been reported in the literature. We present a review of the pathogenesis, clinical manifestations, diagnostic considerations, and therapeutic options.