Scabies. The photograph illustrates the intensity of the pruritus experienced by this child, who has a severe infestation. It has resulted in an extensive erythematous papular rash on the trunk and limbs and scattered hyperpigmented nodules. Numerous diagnostic sarcoptic burrows are present on the infant's palm and wrists, associated with palmar pustules.

Insecticide applied to entire body surface (including scalp): malathion lotion or permethrin cream left for 8 to 12 hours. Repeat in a week and again in a month if symptoms persist. Antipruritic creams: hydrocortisone to all affected areas once or twice daily and emollients as necessary. Oral antibiotics for secondary bacterial infection: flucloxacillin or erythromycin.

Examination and antiscabetic treatment of family members and other contacts, preferably on the same day as the index case. Adults should be treated from the neck down, ensuring insecticide is applied to all skin. Alternative scabicides include gamma benzene hexachloride cream and benzyl benzoate lotion but these may be more irritating than malathion lotion or permethrin cream. Hot wash or dry clean all clothing and linen. Follow up to ensure eradication of infestation and adequate control of secondary dermatitis.