Pediculosis Two species of lice affect humans: Pediculus humanus (capitis or corporis) and Phthirus pubis. Sensitization to louse saliva and antigens results in clinical manifestations.
A. Pediculosis capitis (infestation by head lice). Seen primarily in preschoolers and early elementary school ages but it occurs in all ages and socioeconomic classes (however, low incidence in blacks). Spread by direct contact or on fomites (helmets,
combs, etc.). Diagnosis: pruritus; erythematous papules usually on occiput, postauricular region, and nape of the neck; lice; and nits (eggs firmly attached to hair shaft ~1 cm from scalp. Differential diagnosis: seborrhea, psoriasis, tinea capitis,
impetigo. B. Pediculosis corporis (infestation by body lice). Live in clothing or bedding and not on people. Seen primarily in lower socioeconomic class. The louse bites at night and leaves pruritic vesicles or papules (especially in axillae, groin, and truncal areas). Diagnosis by examination of clothes to find nits or lice. C. Pediculosis pubis (infestation by pubic lice). Transmitted by intimate contact. Diagnosis: pubic or anogenital pruritus, and lice or nits found especially in the pubic hair but also in trunk, beard, eyelashes, or axillae. Often associated with additional STDs. D.Treatment for all the above by a pediculicide.
Treat all sexual partners and household members simultaneously.
Wash all bedding, clothes, towels, and hats in hot water and a hot dryer.
If eyelashes or eyebrows are infested, avoid a pediculicide in those areas. Instead apply petrolatum 5 times a day until clear. Remove nits with forceps.
Pruritus may last for several weeks after successful treatment.
For head lice or crabs. Permethrin (1%) cream rinse is drug of choice applied to scalp after shampooing, left on for 10 minutes, and then rinsed off. Alternative: lindane 1% shampoo. Wash all linens in hot water. Avoid in infants, since may be neurotoxic.
For body lice. Use pyrethrum with piperonyl butoxide lotion over the whole body and in bath; wash off after 10 minutes. Re-treat in 7 to 10 days.
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