Differential diagnoses for a patient that presents with a history of living in a communal-type holding center for the past week, an itchy, pinpoint, papular rash on the extremities can be scabies, insect bites, atopic dermatitis, contact dermatitis, and pityriasis rosea. Due to the fact that the child has been living in a communal-type holding center, there is no telling what insects the child may or may not have been around. An insect bite can present with symptoms of erythema, local pain, pruritus, or edema. Atopic dermatitis was added to the list of differentials because the skin symptoms that can be seen with this condition are acute findings of intensely pruritic erythematous papules and vesicles associated with extensive excoriations,
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Scabies is more likely to occur and be transmitted through close contact with many other individuals, and this patient has been in a communal-type holding center for the past week where he was probably around lots of other individuals. Signs and symptoms seen with scabies can be an itcy rash that starts out mild but progressively gets more intense, worse at night, skin excoriation, erythema, and commonly found on the palms, soles, scalp, face, posterior auriculae, and axillae, concentrated in the folds (Burns, Dunn, Brady, Starr, & Blosser, 2013). Another characteristic physical sign is discrete vesicles and papules distributed in a linear fashion that looks like burrows. The physical exam finding that supports the final diagnosis of scabies is a papular rash on the patient's extremities that is extremely pruritic and in a linear pattern. Also, the placement of the rash, especially in the antecubital fossa, the fact that hydrocortisone made it worse, and excoriation also helps support the …show more content…
Permethrin 5% is the treatment of choice and it should be applied as a single overnight application from the neck down to cover the whole body, and then washed off in 8-14 hours. The patient should be retreated with the topical scabicide in one week (Burns, Dunn, Brady, Starr, & Blosser, 2013). An antihistamine, such as diphenhydramine, may also be given to the patient to help reduce the itching. Education to the foster parent about treating all the family members, friends, and people that had come into contact with the patient for scabies should be encouraged. Also, linens and any clothing that the child had worn in the past 48 hours should be washed with hot water and dried in a hot dryer for 20 minutes to rid the mite (Burns, Dunn, Brady, Starr, & Blosser, 2013). Lastly, the foster mother should be aware that the child's pruritus may continue for up to a week even when the condition has been successfully treated due to local irritation. The child should be brought back into the office in 2 weeks to assess treatment
Scabies is more likely to occur and be transmitted through close contact with many other individuals, and this patient has been in a communal-type holding center for the past week where he was probably around lots of other individuals. Signs and symptoms seen with scabies can be an itcy rash that starts out mild but progressively gets more intense, worse at night, skin excoriation, erythema, and commonly found on the palms, soles, scalp, face, posterior auriculae, and axillae, concentrated in the folds (Burns, Dunn, Brady, Starr, & Blosser, 2013). Another characteristic physical sign is discrete vesicles and papules distributed in a linear fashion that looks like burrows. The physical exam finding that supports the final diagnosis of scabies is a papular rash on the patient's extremities that is extremely pruritic and in a linear pattern. Also, the placement of the rash, especially in the antecubital fossa, the fact that hydrocortisone made it worse, and excoriation also helps support the …show more content…
Permethrin 5% is the treatment of choice and it should be applied as a single overnight application from the neck down to cover the whole body, and then washed off in 8-14 hours. The patient should be retreated with the topical scabicide in one week (Burns, Dunn, Brady, Starr, & Blosser, 2013). An antihistamine, such as diphenhydramine, may also be given to the patient to help reduce the itching. Education to the foster parent about treating all the family members, friends, and people that had come into contact with the patient for scabies should be encouraged. Also, linens and any clothing that the child had worn in the past 48 hours should be washed with hot water and dried in a hot dryer for 20 minutes to rid the mite (Burns, Dunn, Brady, Starr, & Blosser, 2013). Lastly, the foster mother should be aware that the child's pruritus may continue for up to a week even when the condition has been successfully treated due to local irritation. The child should be brought back into the office in 2 weeks to assess treatment