A 5-year-old girl who is well known to your practice attends with her mother. She has been troubled by worsening pruritus over the last six weeks. She has missed more than ten days of school in the last month. Her mother reports that she wakes frequently at night and is lethargic and moody during the day. Her bed sheets are covered in flecks of blood in the morning.
The girl is known to be allergic to egg, fish, and peanut, and has begun to develop the symptoms of seasonal allergic rhinoconjunctivitis within the last couple of months. She has a positive family history of atopy, both parents are allergic to animals and her older brother has asthma. Her younger brother has been sent home from nursery with impetigo recently. Her treatments include an emollient as soap and leave-on preparation and various strengths of topical steroids ranging from very mild to moderately potent depending on…
