A patient presents with profound itching and short, reddish lesions with burrow marks on the wrists. What is the likely diagnosis?

The clinical presentation described—a patient with profound itching and short, reddish lesions with burrow marks on the wrists—strongly suggests a diagnosis of scabies. Scabies is a highly contagious skin condition caused by the Sarcoptes scabiei mite, which burrows into the skin, leading to intense itching and a characteristic rash.

The intense itching associated with scabies is often worse at night and is a result of the body's allergic reaction to the mite, its eggs, and its waste products. The burrows created by the mites are typically seen as thin, grayish or skin-colored lines on the skin, and they are commonly located in areas such as between the fingers, on the wrists, and in other intertriginous zones.

While other conditions like body lice can also cause itching and skin lesions, they do not typically present with the specific burrow marks characteristic of scabies. Rocky Mountain spotted fever and Lyme disease are tick-borne illnesses that can produce rashes and systemic symptoms, but they do not usually lead to the presence of burrows or the intense localized itching seen in scabies.

Given these features, the diagnosis of scabies is the most appropriate in this case, aligning with the symptoms and physical exam findings presented.