Norwegian scabies is a rare, severe form of scabies, often seen in physically or mentally handicapped, immunocompromised, and institutionalized persons. The characteristic skin lesions in this form are gross scaling and hyperkeratotic plaque usually in symmetric distribution. A 55-year-old man presented with generalized pruritic rash. Physical examination revealed scaly erythematous patch with severe crust on his left arm and hand. In contrast, the right hand and arm showed erythematous patches with mildly crusted lesions. The trunk and limbs showed an asymmetrical non-specific rash composed of excoriations and eczematous change, with focal crusting. He suffered from long-standing right hemiplegia with no right hand function. There was no reported case of scabies patient or contact of that matter within the hospital. A scabies mite was seen in KOH examination from the left forearm. The biopsy section from his left forearm showed marked hyperkeratosis and epidermal acanthosis with numerous mites within the stratum corneum. This case is remarkable due to the asymmetric distribution of the burrows, which covered dominantly on the non-paralytic side of the arm. This atypical asymmetric distribution is due to minimal irritation on the non-paralytic side where the mites are left undisturbed for maximal reproduction. Herein, we report a case of asymmetrical Norwegian scabies burrows in a hemiplegic patient.