We performed a cross-sectional study of Hispanic and non-Hispanic parents of children with acne using a survey designed to determine their level of awareness of acne and its treatment; 82% of Hispanic parents and 40% of non-Hispanic parents agreed that a health care provider should treat mild acne (p < 0.001). Hispanic parents of adolescents with acne agreed more frequently than non-Hispanic parents that children with mild and moderate acne should be taken to a health care provider for treatment, but they tended not to visit health care providers. Future studies should aim to determine the reasons for this discrepancy, after which culturally sensitive educational programs can be developed to address this disparity.

Scabies limited to the nail unit is quite unusual, but may persist after treatment of crusted scabies. We present a man with a history of crusted scabies that resolved with treatment, but later the patient reported a chronic problem with crumbly, thickened nails, which were found to be harboring scabies mites. To the editor:A 66 year-old man presented to the dermatology clinic with a complaint of thick, yellow toenails for over one year. He described the nails as "crumbly" and difficult to cut. He had been previously treated for crusted scabies and that eruption resolved with permethrin and ivermectin. He had a history of diabetes but no other immunosuppression.

A 3-year-old boy with mixed-phenotype pre-B-cell acute lymphocytic leukemia and acute myeloid leukemia in the induction phase of chemotherapy presented with a 1-week history of an acute asymptomatic cutaneous eruption. His last chemotherapy regimen administered 1 month before admission consisted of triple intrathecal therapy (methotrexate, hydrocortisone, cytarabine), vincristine, and peg-asparaginase. He had been neutropenic (absolute neutrophil count 0.11 cells/lL) and febrile for 1 week before this cutaneous eruption. He was treated empirically with intravenous (IV) meropenem and micafungin for broad-spectrum antibacterial and antifungal coverage. Amphotericin B was not used initially because of a reported adverse reaction to the medication. Dermatologic examination revealed a few scattered, slightly indurated, nonpurpuric erythematous papules on the scalp, face, back, and extremities (Fig. 1). Punch biopsies of two papules on the arms were obtained for histology ( Figs. 2 and 3) and bacterial, mycobacterial, and fungal tissue cultures.

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