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December 20, 2010

Pruritic Maculopapular Dermatitis in a Household—Quiz Case

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Arch Dermatol. 2010;146(12):1419-1424. doi:10.1001/archdermatol.2010.358-a

A family of 5 residing together in Erie County, New York, presented with a 3-month history of erythematous papules and severe pruritus. The 43-year-old mother exhibited the most extensive symptoms. Her lesions were initially localized to the axillae and waist but subsequently spread to focal areas on the trunk and extremities. Pets present in the household were 7 gerbils and 5 dogs. The family reported a rat infestation in their neighborhood and property.

Physical examination of the mother (Figure 1, left leg) revealed multiple blanching erythematous macules, papules, and ulcerations secondary to excoriation located on the axillae, groin, thighs, and extremities with sparing of the mouth, palms, and soles. No vesicles or pustules were evident. Microscopic examination of skin scrapings was negative for signs of scabies. The family submitted an arthropod (Figure 2, original magnification ×100) collected from the wrist of the 7-year-old son while he sat near the gerbil cages.

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