LAUSR

A 4-week-old infant girl presented with a 5-day history of itchy papules on her arms and the back of her knees. The child had been born at term. Three months earlier, both parents had been treated for presumed scabies with topical permethrin but the mother remained symptomatic. At initial presentation, the infant weighed 4.12 kg and had multiple erythematous/brown shiny nodules with linear brown crusting on the forearms (n = 4) and posterior legs (n = 3), as well as scattered tiny erythematous papules and vesicles affecting the abdomen and limbs. Her mother also had multiple erythematous itchy papules on her feet and one thigh. A diagnosis of scabies was confirmed by dermoscopy and microscopy. The infant was treated with topical permethrin 5% applied to the whole skin below the neck at Week 0 and 1, while the parents were treated with topical permethrin at Week 0, followed by oral ivermectin 200 μg/kg at Week 1 as there were more lesions at that review (Fig. 1a). The family was advised to wash all clothing, bed linen and washable upholstery at 60°C. Despite this, at Week 2, the infant had a total of 29 nodules (Fig. 1b), whereas the rash in both parents was improving. The infant was given a third course of topical permethrin and the parents a second dose of oral ivermectin, followed a week later by topical malathion 0.5% applied to all family members by our dermatology nurses. Despite these treatments, at Week 4 the infant and her father had persistent itchy nodules with burrows. The infant (then 8 weeks and 6 days old, and