ROSH REVIEW Emergency Medicine | 410 Questions with 100% Correct Answers | Verified | Updated 2023 | 236 Pages

A 14-year-old boy presents complaining of intense pruritus in his groin, axillae, and between his fingers after returning home from summer camp 1 week ago. He reports several other campers had similar symptoms. On exam, you note excoriations in the inguinal region and axillae surrounding scattered, erythematous papules. Which of the following is the most appropriate treatment? Ketoconazole Lindane Permethrin Prednisone - Correct Answer ( C ) Explanation: This patient has scabies; a pruritic dermatitis caused by cutaneous infection with the mite Sarcoptes scabei, var hominis. Scabies is spread by skin-to-skin contact and should be considered in patients with generalized pruritus, especially when exposure to others with similar symptoms is reported. The rash of scabies involves papules, which are often excoriated. Burrows are pathognomonic but not uniformly present. Unless previously infected, pruritus generally takes 3-6 weeks to develop because symptoms are due to delayed (Type IV) sensitivity reaction. The pruritus is classically worse at night and affects the web spaces of the fingers, flexor aspect of the wrists, axillae, groin, nipples, and the periumbilical region. Except in cases involving an immunocompromised host, the scalp and face are generally spared. Diagnosis is clinical but can be confirmed by placing scrapings collected with a #15 blade scalpel in mineral oil for