A.B. is a 5-year-old AA male who presented to the clinic with itching around his anal area that began about 4 weeks

A.B. is a 5-year-old AA male who presented to the clinic with itching around his anal area that began about 4 weeks ago and has increased in severity. He is a kindergarten student and his mother reports that the anal itching is moderate. He also has irritation and anal leakage requiring the use of pull-ups at night. It is also reported that the itching has caused difficulty sleeping at night and he awakens multiple times. He has a history of constipation and recently had a change in bowel habits. His mother states he normally has bowel movements daily but in the last 4 weeks since he began school he only has a bowel movement 1-2 times a week. It is reported he bites his nails and has poor hand hygiene following the use of the toilet and before meals. His mother also states that he has started the use of a new bubble bath soap and she has used a new laundry detergent to attempt the decrease the itching.