What is the most likely diagnosis for a 68-year-old female with intense itching that increases at night and papules in specific areas?

The symptoms described in the scenario—intense itching that increases at night and the presence of papules—strongly suggest a diagnosis of scabies. Scabies is caused by an infestation of the skin by the Sarcoptes scabiei mite and is characterized by intense itching primarily due to an allergic reaction to the mites and their waste products. The itching is often worse at night when the mites are more active, and the papules can appear in specific areas such as between the fingers, on the wrists, elbows, buttocks, and genitals, which are common sites for scabies lesions.

In contrast, xerosis, or dry skin, typically presents with dry, flaky skin but does not usually cause the intense itching and specific papular lesions described. Herpes zoster, commonly known as shingles, usually presents with a painful vesicular rash rather than intense itching and is not typically associated with papules in the manner described. Eczema, while it can cause itching and papules, would typically present with a more chronic inflammatory rash and is less likely to show an increase in itching specifically at night.

Thus, the characteristics of the patient's symptoms align best with scabies, making it the most likely diagnosis.