However, lightly stroking the skin with the back surface of the examiner’s fingernail causes whealing (Figure). On examination, some excoriations and broken skin are noted on the boy’s flanks, arm and lower limbs. Three further treatments for the whole family, as well as contact tracing and treatment and management of fomites, have not made any difference to his symptoms. The boy’s mother says that the problem started after the child and the rest of the family were first treated for scabies. The itching is distracting him at school. She has changed her washing powder and the child has been placed on a dairy-free and gluten-free diet, but his symptoms have not improved. His mother says he gets red blotches on his skin that ‘come and go’ and that she has noticed that his nocturnal scratching has been severe enough to cause bleeding, as indicated by blood on his bed sheet in the morning. A 5-year-old boy presents with a history of constant scratching and complaints of itch.
