A patient presents with severe pruritus worse at night and family symptoms. This is most consistent with:

The symptoms described—severe pruritus that worsens at night and a history of similar symptoms within the family—align closely with scabies. Scabies is caused by the Sarcoptes scabiei mite, which burrows into the skin and elicits a strong allergic reaction, resulting in intense itching that is often worse at night when the patient is at rest.

The family history is also significant because scabies is highly contagious and often spreads through close personal contact, meaning that family members are also likely to exhibit similar symptoms. The burrows created by the mites are typically found in specific areas, such as between the fingers, along the wrists, and in skin folds.

In contrast, while lichen planus, impetigo, and psoriasis can also manifest with itching or skin lesions, they do not typically present with the same pattern of nocturnal pruritus or a direct family transmission. Lichen planus tends to show flat-topped, purple papules but lacks the intense itching at night associated with scabies. Impetigo is a bacterial infection that often presents with honey-colored crusted lesions and is not characterized by severe itching or a familial link. Psoriasis, on the other hand, may cause itching, but it