A 42-year-old male who is known to have
Down's syndrome is admitted by his general practitioner for management of an
in tractable itch. The itch is worse at night. He is a long term resident in
an institution for the mentally handicapped
On examination of his skin you notice
multiple vesicles, pustules, papules, burrows and excoriations especially over
the webs of his fingers and in the flexures.
What is the most likely diagnosis?
Polycythaemia rubra vera