An 11-year-old boy is brought to the office by his parents due to a pruritic skin rash for 2 weeks. The rash started on his hands and subsequently spread to the trunk and lower extremities. His mother reports that the patient is constantly scratching the rash and his sleep is now disturbed due to intense pruritus. A cousin who recently visited and shared a room with him had similar symptoms. The patient has had no fever and is up to date with routine vaccinations. Physical examination shows numerous 2- to 3-mm erythematous papules and vesicles with excoriation on his neck, hands, feet, and waistline. His chest and proximal arms and legs are unaffected. Which of the following is the most appropriate initial intervention in management of this patient?

Question

An 11-year-old boy is brought to the office by his parents due to a pruritic skin rash for 2 weeks.  The rash started on his hands and subsequently spread to the trunk and lower extremities.  His mother reports that the patient is constantly scratching the rash and his sleep is now disturbed due to intense pruritus.  A cousin who recently visited and shared a room with him had similar symptoms.  The patient has had no fever and is up to date with routine vaccinations.  Physical examination shows numerous 2- to 3-mm erythematous papules and vesicles with excoriation on his neck, hands, feet, and waistline.  His chest and proximal arms and legs are unaffected.  Which of the following is the most appropriate initial intervention in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d64b_2b8b_bc81_b5c8cff65734_MD0003_00 Scabies, caused by infestation with the mite Sarcoptes scabiei, is characterized by an intensely pruritic rash classically located in the axillae, periumbilical area, genitalia, and interdigital web spaces of the hands and feet. The rash consists of small, erythematous papules or vesicles as well as pathognomonic burrows, or <1-cm lines on the skin, caused by the female mite burrowing into the epidermis to lay eggs. Burrows may not be visible or may be difficult to visualize due to excoriation. interdigital web spaces Scabies is spread by direct person-to-person contact, with an incubation period of 3-6 weeks. Diagnosis is usually clinical but may be confirmed with skin scraping and microscopy to identify mites or eggs. First-line treatment is topical 5% permethrin or oral ivermectin. Prevention of spread includes treating household contacts and decontaminating linens (eg, hot water washing of clothing and bedding). (Choice A) Scabies must be treated to prevent severe disease and spread to others. Supportive care would be appropriate for the treatment of hand-foot-and-mouth disease, which presents with fever, oral lesions, and a maculopapular or vesicular rash on the palms and soles. (Choice B) Oral acyclovir is used in the treatment of varicella for individuals with a risk of complications of disease (eg, pregnant women, adolescents, immunocompromised status). Varicella presents with a prodrome of fever and malaise, followed by successive crops of intensely pruritic vesicles (Choice C) Oral clindamycin is appropriate therapy for extensive impetigo, a superficial bacterial infection of the skin. Impetigo is characterized by erythematous papules or vesicles but classically presents with an overlying, adherent honey-colored crust. (Choice D) Tinea corporis, which is treated with topical antifungals (eg, clotrimazole), is also spread by person-to-person contact and can be intensely pruritic. However, lesions begin as circular patches that spread centrifugally with central clearing and raised borders. (Choice E) Topical corticosteroids (eg, hydrocortisone) are used in the treatment of atopic dermatitis or contact dermatitis, both of which can present with acute, intensely pruritic, erythematous papules. However, the distribution classically involves flexor surfaces (eg, popliteal fossa, antecubital fossa) for atopic dermatitis or areas exposed to the allergen for contact dermatitis. Neither atopic nor contact dermatitis is infectious. atopic dermatitis Educational objective: Scabies is an intensely pruritic rash characterized by small erythematous papules and burrows in the axillae, periumbilical area, genitalia, and interdigital web spaces. First-line treatment is topical 5% permethrin or oral ivermectin. References: Scabies: a review of diagnosis and management based on mite biology. (http://www.ncbi.nlm.nih.gov/pubmed/22210934)

An 11-Year-Old Boy Is Brought to the Office by His