You are asked to evalute a fussy 6-week-old infant with a rash that started on her left axilla 3 weeks ago and spread to the left arm, chest, and abdomen.
The Case
Diagnosis: Scabies
The erythematous papules on this healthy infant were suspicious for scabies. Ectoparasite examination was negative. Herpes viral culture of vesicular fluid was negative.
CLINICAL FINDINGS AND ETIOLOGY
In scabies, the mite Sarcoptes scabiei infests the upper epidermis. Transmission occurs primarily by skin-to-skin contact and occasionally exposure to fomites. There is a resultant erythematous, papulovesicular rash, which may be accompanied by pathognomonic short, wavy, gray, linear mite burrows. Affected areas include axillae, volar wrists, interdigital skin, periumbilical skin, belt line, buttocks, thighs, male genitalia, and female nipple. Infants uniquely may have involvement of the scalp, face, neck, palms, and soles presenting as plaques, pustules, or pinkish-brown nodules.1
Symptoms may be minimal during the first 4 to 6 weeks after exposure. Subsequently, a pruritic, delayed hypersensitivity, eczematous eruption develops that may camouflage the primary scabies' burrows. Reinfested sensitized persons usually become symptomatic within 2 days.2
DIFFERENTIAL DIAGNOSIS
In infants, scabies must be distinguished from dermatitis, urticaria pigmentosa, and papular urticaria.
Recognize & Refer: Hemangiomas in pediatrics
July 17th 2019Contemporary Pediatrics sits down exclusively with Sheila Fallon Friedlander, MD, a professor dermatology and pediatrics, to discuss the one key condition for which she believes community pediatricians should be especially aware-hemangiomas.
Pz-cel granted FDA Priority Review to treat recessive dystrophic epidermolysis bullosa
November 28th 2023The FDA granted Priority Review to pz-cel following a phase 1/2 and a pivotal phase 3 study in which the treatment for recessive dystrophic epidermolysis bullosa (RDEB) demonstrated wound healing and pain reduction.
Worsening severity of AD in children associated with increased comorbidity onset risk
November 27th 2023Of patients in the atopic dermatitis (AD) cohort, 36.6% developed at least 1 comorbidity amid follow-up compared to 28.5% in the non-AD reference cohort, investigators of a Sweden, nationwide, population-based cohort study found.
IDP-126 topical gel approved by FDA to treat acne in patients 12 years and up
October 21st 2023The topical gel is the first and only FDA-approved triple-combination, fixed-dose topical treatment for acne, and is set to be available in the first quarter of 2024, according to Bausch Health Companies Inc.
A 13-year-old girl with well-demarcated rash on back and chest
October 19th 2023A healthy 13-year-old girl presented with a 1-month history of an asymptomatic, well-demarcated rash on her back and upper chest. The eruption consisted of discrete, dark brown papules that coalesced into large, flat-topped plaques with mild superficial scale and accentuation of skin markings. What's the diagnosis?