A 2-year-old girl presented with a 1-week history of a worsening papular rash associated with intense pruritus on the trunk, arms, and hands. According to her parents, the itching was worse at night and they did not use any oral or topical medications before the onset of pruritus. Moreover, they deny any history of allergies, concurrent fever, or other illness.

Vaccination: Up-to-date Social history: Summer vacation to the mountains three weeks before her parents noticed the skin rash.