a) Hodgkin’s disease _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

b) scabies _ _ _ _ _ _ _ _ _ _ Correct ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

c) detergent allergy _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

d) pityriasis lichenoides chronica _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

e) pityriasis rosea _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

i) permethrin (Nix cream) _ _ _ _ _ _ _ _ _ _ Correct ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

ii) topical steroids _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

iii) UVB phototherapy _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

iv) antihistamines _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

v) chemotherapy _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

Answer and Commentary _ _ _ _ _ _ _ _ _ _ Intensely pruritic, inflammatory nodules on the scrotum are diagnostic of scabies. The lesions are known as persistent scabies nodules and indeed they usually persist following treatment for the scabies. These lesions show an intense lymphocytic infiltrate and may represent a hypersensitivity reaction to the scabies mite. They are best treated with intralesional steroids. These lesions may also be found in the groin, axillae and in the submammary fold. The appropriate treatment for this patient would be permethrin cream from neck to toes, followed by intralesional steroid injections if the lesions persisted. The entire household should also receive the permethrin treatment. An alternative treatment for the scabies would he gamma- benzine hexachloride - again from neck to toes. Repeat treatment a week later if necessary. ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯