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- Ross Brockman, DO*
- Sabra Leitenberger, MD*
- *Department of Dermatology, Oregon Health and Science University, Portland, OR
AUTHOR DISCLOSURE
Drs Brockman and Leitenberger have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of unapproved/investigative uses of commercial products/devices.
- CDC:
- Centers for Disease Control and Prevention
- CLIA:
- Clinical Laboratory Improvement Amendments of 1988
- CNS:
- central nervous system
- EH:
- eczema herpeticum
- FDA:
- Food and Drug Administration
- GABHS:
- group A β-hemolytic Streptococcus
- HFMD:
- hand-foot-mouth disease
- HSV:
- herpes simplex virus
- MC:
- molluscum contagiosum
- PCR:
- polymerase chain reaction
Education Gaps
Scabies is a common infestation of childhood but it can have an atypical appearance during infancy, with exuberant inflammation and pustules. We review the diagnosis and management of scabies, with emphasis on issues specific to the pediatric population. There is a wide range of infections that can also cause pustules in early childhood, and several of the most common are highlighted in this article to help the clinician differentiate these entities and select appropriate treatment strategies based on best-available evidence.
Objectives
After completing this article, readers should be able to:
Recognize the variable presentation of scabies in infants, children, and immunosuppressed individuals.
Understand best-practice strategies for treating scabies, including that the first-line medication is permethrin 5% cream and all household contacts should be treated.
Inflammation of molluscum lesions is often related to immune response and imminent clearance.
Topical corticosteroids may be used to treat underlying dermatitis in eczema herpeticum, provided the patient is receiving adequate systemic antiviral treatment.
Atypical presentations of hand-foot-mouth disease can mimic eczema herpeticum.
Onychomadesis may occur after hand-foot-mouth disease.
Introduction
In this article, scabies infestation in infants and young children is covered in detail. In addition, the following common diagnoses with infectious etiologies that can also cause widespread pustules in children are reviewed: molluscum contagiosum, 2 manifestations of herpes simplex virus (HSV) infections (eczema herpeticum [EH] and neonatal HSV), hand-foot-mouth disease (HFMD), and impetigo. Tips on how to recognize these entities, information on pathophysiology, and treatment updates are reviewed herein and summarized in the Table. It is important to consider that a full differential diagnosis of a pustular rash in children may additionally include many other infectious and noninfectious etiologies. …
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