Skin Disorders Case

A 12-year-old girl returns home from summer camp noting severe itching, which is most pronounced at night.

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A 12-year-old girl returns home from summer camp noting severe itching, which is most pronounced at night. You note that papules and linear tracks are concentrated on her wrists and the web spaces of her hands.

What is the most appropriate next step?

A. Biopsy to confirm diagnosis.
B. Empiric treatment with a topical steroid.
C. KOH examination.
D. Mineral oil preparation.
E. Tzanck preparation.
The correct answer is “D.” Pruritic rashes that concentrate in web spaces and display linear burrows are classic for scabies. (See Figure 33–32.) A mineral oil preparation (scabies prep) is used to confirm the diagnosis. (See Table 33–7.) Scabies mites infest the stratum corneum, so they are readily detected by skin scraping, application of a drop of mineral oil, and observation of mites, eggs, or scybala (feces) under the microscope. Biopsy is usually unnecessary to diagnose scabies. Not everyone has immediate access to a microscope, so it is reasonable to treat empirically for scabies.

Leah Carton

Editorial Coordinator , McGraw-Hill Education

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