An infant presents with pruritic lesions distributed over the hands, feet, and periumbilical region. Which of the following diagnoses best fits this clinical picture?

1. A

   A. Atopic dermatitis

2. B

   B. Bullous impetigo

3. C

   C. Scabies

4. D

   D. Eczema

Appeared in: INI-CET EXAM -2026

Explanation

• The correct diagnosis is scabies, an infestation by the mite Sarcoptes scabiei.
• In infants, the distribution of scabies is different from that in adults and characteristically involves the palms, soles, face, and scalp, in addition to the trunk.
• The combination of intense pruritus and the specific location of papules and vesicles on the hands and feet is a classic presentation of infantile scabies, as confirmed by the provided image.
• The periumbilical involvement mentioned in the question stem is also consistent with the generalized nature of scabies in infants.

Why Other Options Were Wrong

• Option A: Atopic dermatitis (a type of eczema) in infants typically presents with dry, erythematous, and scaly patches on the face, scalp, and extensor surfaces of the limbs. It usually spares the palms and soles.
• Option B: Bullous impetigo is a bacterial skin infection characterized by large, flaccid blisters (bullae) that rupture and form honey-colored crusts. The lesions in the image are small papules and vesicles, not large bullae.
• Option D: Eczema is a general term for dermatitis. While scabies can cause an eczematous reaction, the specific pattern (location on hands/feet) points directly to scabies as the primary cause rather than a primary eczematous disorder like atopic dermatitis.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differential diagnosis of common pediatric dermatological conditions to guide bedside assessment, documentation, and the next nursing action.
• Scabies is highly contagious. It is crucial for the nurse to educate the family that all household members and close contacts must be treated simultaneously, even if they do not show symptoms, to prevent re-infestation.
• Environmental decontamination is a key nursing intervention. This includes washing all bedding, clothing, and towels used in the last 72 hours in hot water and drying on a high heat setting.
• Items that cannot be washed should be sealed in a plastic bag for at least 72 hours to a week, as the mite cannot survive for more than 2-3 days away from human skin.

How to Approach the Question

• First, analyze the patient's demographic: an infant. Recognize that disease presentations can differ significantly between infants and adults.
• Identify the key symptom: pruritic (itchy) lesions. This narrows the possibilities to inflammatory or infectious conditions.
• Examine the distribution of the lesions: hands, feet, and periumbilical region. This is the most critical clue.
• Correlate the distribution with the classic patterns of the diseases listed in the options. Recall or look up that scabies in infants classically affects the palms and soles.
• Analyze the image, which shows papules/vesicles on the soles, confirming the physical findings consistent with the specific distribution.
• Synthesize these clues to conclude that scabies is the diagnosis that best fits all the provided information.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of common pediatric dermatological conditions.
• Stem keywords: infant, pruritic lesions, hands, feet, periumbilical region
• Lead-in keywords: best fits
• Clinical cues: Patient is an infant, which alters the typical distribution of the rash.
• Clinical cues: Lesions are on hands and feet, a classic sign of infantile scabies.

Question ID

QudLyQ3RNYcOMUfZ8Me_8F

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1428-1430

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 724-726