There can also be involvement of the face, scalp, and the tops and soles of the feet-areas that are rarely involved in adults. The pattern of scabies in infants is often more widespread and eczematous than in children and adults. This form of scabies is more common in adults than in children. The nodules are usually found on the lower abdomen, the buttocks, and the male genitalia. These lesions can become firm, slightly brownish in color, and excoriated. There are some individuals who develop only a few pruritic lesions. The lesions may not be typical in appearance or distribution and can be unusual. Given the ubiquitous use of topical corticosteroids, the signs and symptoms of scabies can be masked in this form of the disease. Special forms of scabies Scabies incognito The classic burrow-a short, linear, and sometimes wavy lesion-is frequently absent. Nocturnal pruritus is an important diagnostic feature, especially when the common nonspecific anti-itch treatments have not been helpful. Diffuse excoriation and eczematization, sometimes with secondary pyoderma, can obscure the classic features of scabies. Pruritic, excoriated, penile papules are almost always scabietic in origin. The classic presentation consists of small, symmetrical, pruritic, erythematous papules involving the hands (particularly the web spaces of the fingers), flexural aspects of wrists, anterior axillary folds, buttocks, and genitalia ( Figure 1). If more than one family member develops a pruritic eruption, scabies is the most likely cause. In children it is usually spread by non-sexual contact within families and between playmates. Scabies is easily transmitted by close skin-to-skin contact. It was first identified in 1687, which makes it one of the first diseases with an identifiable agent-Sarcoptes scabiei var. Scabies is common, pruritic, and often difficult to diagnose. Frequently it can take more than one visit to establish the cause of the problem, much to the frustration of the patient and family. The pattern of involvement, the location of the eruptions, and any secondary lesions can also be of help. When establishing the cause of a pruritic eruption in a child, as in an adult, the first step is to identify the primary lesion. The conditions that most commonly produce “rashy, itchy kids” are scabies, atopic dermatitis, papular urticaria, insect bites, eczematized molluscum contagiosum, and urticaria. There are numerous causes of pruritus in children. Individuals can usually ignore the sensation, although adults are better at this than children.
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