JAMA Pediatrics Clinical Challenge
Infant With a Papular Eruption Localized to the Back
Karin Eshagh, BA
Cynthia M. C. DeKlotz, MD
Sheila Fallon Friedlander, MD
A 9-week-old girl had a rash on her back that had been present for 7 weeks. The rash was asymptomatic and started as red bumps that then evolved into pustules and blisters. On further questioning, it was discovered that the patient’s father worked in a nursing home that had experienced a recent outbreak of scabies. Shortly after the onset of the outbreak, the patient and all family members were treated with 2 once-weekly doses of permethrin, 5%, cream. All other family members had significant improvement with the treatment; however, our patient’s lesions continued to worsen during the subsequent 2 weeks. On physical examination, the patient had numerous erythematous macules, papules, and pustules on her back. Many of the lesions had superimposed hemorrhagic crust and surrounding scale. In addition, several grouped papules were noted, including some in a linear array (Figure 1A and B). The rest of her cutaneous examination results were unremarkable except for a few fading pink papules noted on her left abdomen (Figure 1C).
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Author Affiliations: Eshagh, DeKlotz, and Friedlander (email@example.com) are affiliated with the University of California, San Diego, School of Medicine, La Jolla, and DeKlotz and Friedlander are affiliated with Rady Children's Hospital, San Diego, California.