A six-month-old boy presented with recently developed vesiculopustular lesions on the soles of both feet. He was born at term with no perinatal issues. Two weeks earlier, he was treated with a topical corticosteroid for allergic contact dermatitis, which did not lead to marked improvement.

Physical examination revealed tiny, scaly vesicles and pustules on the soles extending to the lateral sides of the feet (Figure 1 and Figure 2). Some were erythematous, and others were the same color as the patient’s skin. Nodules were also found on the lower abdomen and perineal area. A few of the infant’s family members reported experiencing pruritus but did not have skin lesions.

Question

Based on the patient’s history and physical examination findings, which one of the following is the most likely diagnosis?

• A. Bullous impetigo.

• B. Infantile acropustulosis.

• C. Infantile scabies.

• D. Langerhans cell histiocytosis.

Discussion

The answer is C: infantile scabies. Microscopic examination of skin scrapings revealed live mites. Infantile scabies was diagnosed, and the patient was treated with permethrin 5% cream. Oral antihistamines were also prescribed to alleviate pruritus. The lesions resolved without recurrent skin eruptions.