A 6-year-old boy presents with widespread pruritic papules with erythema, xerosis, and extensive excoriations and erosions with serous exudation on the flexural surfaces of the extremities, neck, wrists, and ankles. The lesions cover nearly 15% of his body surface area (BSA). The patient describes them as intensely itchy, and his mother reports him achieving little to no relief with over-the-counter, topical anti-itch preparations (eg, zinc oxide, hydrocortisone). The itchiness is interfering with the patient's sleep as well as his mother's, which she states is negatively affecting her performance and productivity at work. The patient is also "very cranky" according to parental reports. His medical history is positive for mild atopic dermatitis (AD) at 2 years of age, which resolved after a course of topical corticosteroids and regular use of emollients. Family history includes asthma (father) and allergic rhinitis (mother). The family recently returned from a trip to the Caribbean where they enjoyed swimming and snorkeling; the patient's symptoms began toward the end of the vacation and have progressively worsened. No one else in the family has been unwell.