6-year-old male. Attends elementary school; develops intensely pruritic rash on wrists, umbilicus, hands, and feet. No sick contacts.
Excoriated scaly papules clustered on the wrists/hands, umbilicus, and scattered across the trunk; genitalia, face, and scalp are spared. Initial evaluation A skin scraping taken from the feet reveals mites and eggs The patient is prescribed: Permethrin 5% cream, to be applied overnight to the whole body except face/ scalp and repeated in 1 week Triamcinolone 0.1% ointment b.i.d. (started 24 hours after first anti-parasitic treatment) Hydroxyzine for nocturnal pruritus Simultaneous treatment of entire family and babysitter is mandatory Instructions for decontamination protocol are given Report to school infection control Follow-up in 2 weeks Follow-up evaluation Patient’s eruption has resolved, but pruritus persists Patient has several follicular-based…
