The Itch That Rashes
Maria, a 2-year-old, presents in your urban-based primary care clinic for an initial visit with a chief complaint of repeated episodes of easily irritated and itchy skin. The family emigrated to the United States from Honduras shortly after she was born. Through a translator, her mother reports that Maria has not been sleeping well at night "for weeks" due to persistent scratching that frequently wakens her and is associated with bloody spots found on the sheets in the morning. Although her scratching is worse at night, she also has daytime scratching that often disrupts her play. She is afebrile, and her mother denies respiratory symptoms, fever, vomiting, or diarrhea. There is no history of recent travel, new clothing, or oral medications.
What is causing this persistent itch?
Her skin care routine includes being bathed every other day with a perfumed baby wash. Her mother "sometimes" applies baby lotion to Maria's skin.
Family history is negative for eczema, allergies, or asthma. She has a 5-month-old sibling who was recently noted to have itchy, dry patches of skin on his trunk and extremities.
Social history reveals that Maria lives in a carpeted apartment with her parents, her younger brother, and several other aunts and uncles. There are 2 pet cats in the home. She is home full-time with her mother with the exception of attending church nursery each week.
The Case of the Itch That Won't Quit
History
Maria, a 2-year-old, presents in your urban-based primary care clinic for an initial visit with a chief complaint of repeated episodes of easily irritated and itchy skin. The family emigrated to the United States from Honduras shortly after she was born. Through a translator, her mother reports that Maria has not been sleeping well at night "for weeks" due to persistent scratching that frequently wakens her and is associated with bloody spots found on the sheets in the morning. Although her scratching is worse at night, she also has daytime scratching that often disrupts her play. She is afebrile, and her mother denies respiratory symptoms, fever, vomiting, or diarrhea. There is no history of recent travel, new clothing, or oral medications.
What is causing this persistent itch?
Her skin care routine includes being bathed every other day with a perfumed baby wash. Her mother "sometimes" applies baby lotion to Maria's skin.
Family history is negative for eczema, allergies, or asthma. She has a 5-month-old sibling who was recently noted to have itchy, dry patches of skin on his trunk and extremities.
Social history reveals that Maria lives in a carpeted apartment with her parents, her younger brother, and several other aunts and uncles. There are 2 pet cats in the home. She is home full-time with her mother with the exception of attending church nursery each week.
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