PEDICULUS HUMANUS CAPITIS

Question 1

Presentation

Answer 1

(1) Head lice are 3-4 mm in length. They can be seen on the hair shafts and scalp with careful observation.
(2) Nits are sometimes easier to see than the lice and are fluorescent.
(3) Diagnosis is not usually difficult, but may require repeated examinations.
(a) Pruritus with excoriation.
(b) Occasionally, sky-blue macules (maculae ceruleae) on the inner thighs or lower abdomen in pubic louse infestation
(c) Eyelash infestation may induce blepharitis, with lid pruritus, scaling, crusting and purulent discharge

Question 2

Treatment

Answer 2

(1) Permethrin rinse 1% (Nix); Permethrin 5% (Elimite); Lindane % (Kwell)
(a) Sexual contacts/family members should also be treated.
(b) As a last resort, shaving hair can be curative.
(2) Removing nits is essential (Nit combs)
(a) If you kill the lice but leave the nits, they come back in 8-10 days.
(b) Hair saturated with a solution of 50% vinegar and 50% water, applied and removed in 15 minutes may help to “unglue” nits.
(3) Clothes and bedclothes should be washed and dried at high temperature if possible.
(4) Alternative Therapies or “Home Remedies”:
(a) Vaseline (Petrolatum) to the scalp overnight and covered with a shower cap, smother the lice.
(b) This treatment does not kill nits, so it should be repeated for 3-4 weeks.
(c) Hair Clean 1-2-3 hairspray is an oil that kills lice in 15 minutes

Question 3

Differential Diagnosis

Answer 3

(1) Seborrheic Dermatitis
(2) Impetigo
(3) Insect Bites - bed bugs

Question 4

Labs/Studies/Imaging

Answer 4

(1) Woods Lamp

(2) Adequate lighting & magnifying glass

Question 5

Disposition

Answer 5

(1) Full Duty, considerations taken for laundering clothing, bedding and those
in close quarters with other persons

Question 6

Complications

Answer 6

(1) Secondary infections

(2) Recurrence