Which symptom is often associated with scabies infestation?

Burrow marks are a key symptom associated with scabies infestation and are formed as the mite, Sarcoptes scabiei, burrows into the upper layer of the skin. These burrows are typically seen as thin, grayish-white or flesh-colored lines on the skin, often accompanied by erythema (redness) and intense itching. The itching is due to the body's allergic response to the mite, its eggs, and its feces, and is particularly severe at night.

Other symptoms mentioned, while they may relate to various dermatological conditions, do not specifically characterize scabies. Painful lesions can arise from secondary infections due to scratching but are not a defining feature of scabies itself. Pustules may be secondary manifestations of inflammation or infection from scratching and are not indicative of the scabies infestation per se. Hyperpigmentation can occur in various skin conditions and can result from post-inflammatory changes but does not occur as a primary symptom of scabies.

Thus, the presence of burrow marks is a distinct and diagnostic feature of scabies that helps differentiate it from other skin conditions and highlights the characteristic nature of the infestation.