Infantile scabies mimicking refractory eczema: a case report and review of the literature.

Atypical infantile scabies is easily misdiagnosed as common inflammatory dermatoses, leading to therapeutic delay. This 11-month-old female infant presented with two months of generalized pruritus and steroid-refractory palmoplantar pustules, which failed to respond to topical glucocorticoids and calcineurin inhibitors. Epidemiological inquiry revealed familial clustered pruritus and definite occupational scabies exposure in her mother, a ward nurse. Dermoscopy directly identified mites and confirmed the diagnosis. Standardized sulfur ointment treatment for the infant and synchronous eradication therapy for all household members achieved remission. This case highlights that anti-inflammatory-refractory palmoplantar pustules are crucial red flags for atypical infantile scabies. For intractable eczema-like eruptions in infants, targeted contact tracing and dermoscopic evaluation should be prioritized over prolonged empirical anti-inflammatory therapy to enable early and accurate diagnosis.