Scabies in infants and small children

Scabies in infants and young children manifests as a pruritic, often generalized eruption with frequent involvement of the face, scalp, palms, and soles, in contrast to the intertriginous localization of lesions in older patients. The most common presenting lesions are papules, vesiculopustules, and nodules. Secondary eczematization and impetiginization are common, but burrows are difficult to find. The diagnosis of scabies should be confirmed by mineral oil scraping. Permethrin 5% cream (Elimite; Herbert, Irvine, CA) is now considered to be the treatment of choice for infants and small children with scabies because of its high efficacy and low risk of side effects. Concomitant treatment of other family members and caretakers is imperative, as is cleansing of articles of contact. Postscabietic nodules may persist for a few months after clearance of the mites. Animal scabies may also cause pruritic papules and vesicles in young children, but the eruption clears spontaneously; the infested animal should be treated.