Case of the Month Charles Crutchfield

An infant with papules and pustules on feet. What is your diagnosis? Dr. Crutchfield’s Case of the Month

Foot sores

11-month-old infant presents with pruritic crusted papules and pustules on feet, as seen in the picture. Also hand and axilla involvement. A teen cousin visiting for the summer has a similar rash, and both are very pruritic.

Here is a picture of a mineral oil scraping I took through the microscope ocular with my cell phone.

Microscopic photo

What is your diagnosis?

Diagnosis: Scabies.

The diagnosis can be made, microscopically, with the detection of any one of these three items:

mites,

scybala(poop)

ova (eggs).

In this micrograph both scybala and eggs can clearly be seen, with a questionable mite just under the tip of the pointer.

I treated the child with permethrin cream, neck down, overnight, weekly for three weeks.

I also treated the teen cousin with the same protocol but added ivermectin, 9 mg weekly x 3 weeks.

I treated all others, living in the same house, but not symptomatic, with permethrin cream, neck down, overnight, for the first week.

I cautioned the mother it might take 2 or more weeks for the child’s bumps and itching/symptoms to subside. To make sure the proper amount is given, as just a rough rule-of-thumb, it usually takes 60 grams of cream to cover an adult and 30 grams of cream to cover a child.

At a 1 month re-check, the family was clear.


Case of the Month Studies from Charles CrutchfieldFor more dermatology cases-of-the-month visit the Dermatology Case of the Month Archive by Charles Crutchfield III, MD

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