Children afflicted with insect-bite rashes are often misdiagnosed or referred for extensive and costly tests, but a new, easy-to-remember set of guidelines developed at the Johns Hopkins Children's Center should help.

Called SCRATCH, the letters form a memorable acronym for symmetry, cluster, Rover, age, target/time, confused, household). It is a guide to the symptoms and features that help pediatricians and others to recognize the source of a rash.

Insect-bite skin rashes mimic the symptoms of a variety of conditions, ranging from fungal infections, scabies, allergies and environmental contacts, to HIV-associated dermatoses. Reactions to a bite are often delayed, making it difficult to trace exposure.

"SCRATCH could spare many children and their parents from going through invasive-not to mention expensive-procedures if pediatricians recognize the problem early on," says Raquel Hernandez, M.D., a third-year resident at the Children's Center and lead author of the article, published in the July online edition of Pediatrics.

Hernandez and co-author Bernard Cohen, M.D., head of dermatology at the Children's Center, developed SCRATCH by examining a month's worth of patient records from visits to the Children's Center dermatology clinic. They found that the majority of children who were eventually diagnosed with an insect-bite rash had undergone extensive lab tests and skin biopsies before they were referred to Hopkins.

The most common misdiagnosis was scabies, a skin infection caused by a parasite that produces red, itchy lesions. Many of the children were treated repeatedly for scabies.

"These guidelines are really intended to make pediatricians consider insect-bite hypersensitivity as a diagnosis and think twice before referring a child for a skin biopsy or another invasive procedure," Cohen says.
Using the tool is straightforward, Cohen adds. If the rash fits the SCRATCH
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Contact: Katerina Pesheva
epeshev1@jhmi.edu
410-516-4996
Johns Hopkins Medical Institutions
28-Jun-2006