Infant With a Papular Eruption Localized to the Back

Abstract

A 9-week-old girl had a rash on her back that had been present for 7 weeks. The rashwasasymptomatic andstartedas redbumps that then evolved into pustules and blisters. On further questioning, it was discovered that thepatient’s fatherworked in a nursing home that had experienced a recent outbreak of scabies. Shortly after the onsetof theoutbreak, thepatient andall familymemberswere 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 erythematousmacules, papules, andpustules onher back.Manyof the lesions had superimposed hemorrhagic crust and surrounding scale. In addition, several grouped papules were noted, including some in a linear array (Figure 1A andB). The rest of her cutaneous examination results were unremarkable except for a few fading pink papules noted on her left abdomen (Figure 1C). A B C