This 1-month-old irritable girl was brought by his mother for the evaluation of a generalized eruption with involvement of the soles and palms. Her mother also had a pruritic eruption involving the trunk and limbs from neck down but sparing the palms and soles.
Scabies was first recognized during the middle ages. It is an extremely pruritic, highly contagious infestation of the skin caused by the mite Sarcoptes scabiei. Scabies is usually transmitted by direct contact with an affected individual although transmission from fomites is also possible. The female mite burrows into the epidermis after mating with the male on the skin surface.. She lays about 3 eggs/day over a 30-60 days life time. The eggs hatch to form larvae which leave the burrow to mature on the skin surface. A delayed type IV hypersensitivity reaction to the mites, their eggs, and scybala, that occurs approximately 30 days after infestation, is responsible for the intense pruritus. Itching, especially at night, usually spares the head and neck in adults but not in the neonates and infants where lesions are also found on the palms and soles such as in this case. The characteristic linear or S-shaped burrows are clustered on the web spaces of the fingers, flexor surfaces of the wrists, elbows, axillae, belt line, feet, and scrotum in men and areolae in women. Burrows are commonly found on palms and soles in infants. The examination of skin scrapings from burrows under light microscopy usually reveals mite, eggs, larvae and scybala. All family members and close contacts of the patient must receive treatment that consists of an overnight application of a topical scabicide. This patient and all the family members were treated with topical permethrin 5 percent cream .
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generalized edematous erythematous scaly crusted papules and vesicles