A case of neonatal scabies: JAMA
A 7-week-old, previously healthy full-term male infant presented with a 4-week history of a worsening, widespread, papulopustulovesicular eruption, which began as scattered papulovesicles over the chest. Since the rash developed, the infant had been fussy with increasing restlessness at night. On further questioning, the parents reported that the infant had had contact with a babysitter who reported pruritus, especially at night. The sitter had provided domestic care for the infant since birth until leaving that position 3 weeks earlier.

On examination, the infant was afebrile with normal vital signs. Multiple disseminated, edematous, pin-sized, papulopustulovesicles and 5- to 10-mm coalescing, crusted nodules were found all over the body; some with oval to elongated, serpiginous or J-shaped burrows. No excoriations were visible.

The patient and the babysitter underwent skin scraping with microscopic findings of numerous mites. The infant was treated with a sulfur ointment (5%) for 3 consecutive days and treatment was repeated 1 week later, with rapid recovery of normal temperament, good sleep, and complete resolution of the rashes.

The babysitter was treated with a permethrin cream (5%) that was reapplied 1 week later, and all family members received prophylaxis with 1 cycle of permethrin therapy. Besides hygienic cleaning of fixtures and appliances, all bedding, clothing, and towels were washed in hot water and dried with high heat to decontaminate. Three months later, the infant and all contacts had no evidence of scabies.

Major takeaway:-
- The key to the correct diagnosis is the widespread inflammatory burrows without excoriations, the history of contact with a babysitter with symptoms consistent with scabies, and the fussiness and restlessness at night in an otherwise healthy neonate.

- Unlike in adults, the palms, soles, trunk, and skin above the neck are commonly affected by characteristic scabies skin lesions in neonates.

- Contact with an individual with signs and symptoms of scabies can strongly suggest the diagnosis.

Know more here: https://jamanetwork.com/journals/jama/fullarticle/2721290
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