Young & Crusty

4. The rash on this 5-month-old baby’s hands manifested several weeks ago. It spread to his arms and trunk and is now essentially everywhere except his face. Despite a number of treatment attempts, including oral antibiotics and OTC topical steroid creams, the problem persists.

Diagnosis: The diagnosis of scabies should be confirmed, whenever possible, with microscopic scabetic findings. In addition, treating the whole family and identifying the source of the infestation are crucial. Diagnosis of scabies is difficult in infants, as any part of an infant’s thin, soft, relatively hairless skin is fair game (whereas, in adults, scabies rarely affects skin above the neck). And although infants with scabies undoubtedly itch—probably just as much as adults—they are inept excoriators and even worse historians. In contrast, adults with scabies will scratch and complain continuously while in the exam room.

For more information, see “Baby Has Rash; Parents Feel Itchy.” Clinician Reviews. 2014;24(9):W3.