Infant With a Papular Eruption Localized to the Back

Abstract

A 9-week-old girl had a rash on her back that had been present for 7 weeks. The rash was asymptomatic and started as red bumps that then evolved into pustules and blisters. On further questioning, it was discovered that the patient's father worked in a nursing home that had experienced a recent outbreak of scabies. Shortly after the onset of the outbreak, the patient and all family members were treated with 2 once-weekly doses of permethrin, 5%, cream. All other family members had significant improvement with the treatment; however, our patient's lesions continued to worsen during the subsequent 2 weeks. On physical examination, the patient had numerous erythematous macules, papules, and pustules on her back. Many of the lesions had superimposed hemorrhagic crust and surrounding scale. In addition, several grouped papules were noted, including some in a linear array ( Figure 1A and B). The rest of her cutaneous examination results were unremarkable except for a few fading pink papules noted on her left abdomen ( Figure 1C).

Scabies in babies

“…The diagnosis can be confirmed by identification of mites, eggs, or fecal pellets on microscopic examination of scrapings from burrows . Direct dermatoscopic examination of intact burrows will demonstrate the presence of the delta‐wing and contrail signs typical of the mouth parts of female mites and burrows …”

“…4 In families in which scabies is suspected but not confirmed by ectoparasite scraping, examination and scraping of infested infants in the family is usually diagnostic. 6 In infants, scabies burrows are typically located on the head, neck, chest, abdomen, back, palms, and soles. 1,2,9 In our patients, the trunk was involved early in the majority of infants.…”

“…2,3 Direct dermatoscopic examination of intact burrows will demonstrate the presence of the delta-wing and contrail signs typical of the mouth parts of female mites and burrows. 6 Infantile scabies is a common problem that requires proper management to prevent spread and complications of chronic infestation.…”

“…Newborns and infants often present early in the course of infestation with highly inflammatory burrows characterized by red, edematous, crusted, oval to elongated, serpiginous or J-shaped papulovesicles and nodules. 1,4,6 Moreover, unlike older children and adults, who present with widely disseminated lesions, the early eruption in infants is often localized. Delay in diagnosis and treatment has been associated with superficial skin infections, including bullous impetigo, ecthyma, and cellulitis, as well as poststreptococcal glomerulonephritis, leukocytoclastic vasculitis, irritability, and failure to thrive.…”

“…The clinical presentation in infants is different from that in older children and adults. Newborns and infants often present early in the course of infestation with highly inflammatory burrows characterized by red, edematous, crusted, oval to elongated, serpiginous or J‐shaped papulovesicles and nodules . Moreover, unlike older children and adults, who present with widely disseminated lesions, the early eruption in infants is often localized.…”