The FP suspected scabies, realizing that in addition to the classic burrows seen between the fingers, scabies may present with pruritic nodules in the axilla or genital region. This child did not have any visible burrows between his fingers and there was no involvement of the genital area. Using dermoscopy, scabies mites were seen as triangular structures with trailing burrows over some of the nodules. The mother agreed to have her hands examined and scabies mites were seen between her fingers.
The child weighed less than 33 pounds, so he was not an appropriate candidate for oral ivermectin. The physician prescribed 5% permethrin cream for the child, mother, and other household members. The FP explained the importance of applying the cream from the neck down to the toes overnight and washing it off in the morning. Toddlers often have the scabies mites above the neck, so the mother was counseled to apply the 5% permethrin cream on her son’s head and face, being careful to avoid his mouth and eyes. The FP also gave the family directions to wash their clothes and bedclothes.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Chanoine P, Smith M. Scabies. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:575-580.
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