Figure 1

ReginaldoCastro

Specialty: Internal Medicine

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.

Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

Update 1

The leading diagnosis is scabies based on the intense pruritus, papulovesicular eruption, and involvement of the lumbar and gluteal regions. The history of caring for rescued dogs also raises the possibility of transient zoonotic scabies or flea bites, making papular urticaria an important differential diagnosis. Empirical treatment with 5% permethrin (or oral ivermectin when indicated), along with treatment of close contacts and environmental measures, would be an appropriate initial approach.

Diagnosis Added

Diagnosis: Scabies

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