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Pediculosis Clinical Manifestations and Treatment

Pediculosis Clinical Manifestations and Treatment

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Pediculosis Dr. Fatimah Jaber Ghazwani (Family medicine - R2)
Table of contents 01 04 02 05 03 06 Introduction Types of Lice Epidemiology Clinical Manifestations Diagnosis Treatment
Introduction to Pediculosis Pediculosis, commonly known as head lice infestation, is caused by Pediculus humanus capitis. Lice are small, wingless insects that survive by feeding on human blood. They lay eggs (nits) on the hair shaft near the scalp.
Types of Lice Head Lice Body Lice (Pediculus humanus capitis) – Found on the scalp. (Pediculus humanus corporis) – Lives in clothing, moves to skin to feed. (Pthirus pubis) – Found in the genital area, eyebrows, eyelashes. Pubic Lice
Epidemiology Most common in children attending schools and daycare. Not related to poor hygiene or hair length. Spread primarily through direct head-to- head contact. Indirect transmission through combs, brushes, and hats is uncommon.
Clinical Manifestations Pruritus occurs as an allergic reaction to lice saliva injected during feeding. In a patient without prior infestation, the onset of itching may be delayed until sensitization occurs after four to six weeks. In addition to lice and nits, excoriations may be visible on the scalp, neck, and postauricular skin. Infrequently, secondary staphylococcal infection occurs with associated cervical or nuchal lymph node enlargement.
Multiple excoriations and crusts on the posterior neck in a patient with pediculosis capitis.
Use of a fine-tooth lice comb. Diagnosis Systematically combing wet or dry hair with a fine-toothed nit comb better detects active infestation . Unlike seborrheic scales, hair casts, and hair spray residue, nits are cemented securely to the hair shaft and are difficult to dislodge. Light microscopy or dermoscopy can be used to confirm a nit. Pediculosis capitis should be suspected in patients with scalp pruritus, particularly in children. The diagnosis is confirmed by the visualization of live lice Visual inspection for live lice and nits.
Live lice and nits on the hair.
Multiple nits on the hair shafts.
Dermoscopy of pediculosis capitis Viable nit Nonviable nits (empty louse egg cases)
Treatment
Treatment Options 1-Topical pediculicides : Examples of effective topical pediculicides include: • Pyrethroids (pyrethrins, permethrin) • Malathion • Spinosad • Topical ivermectin Topical pediculicides should be rinsed off with water after the recommended time. Hair should not be washed with shampoo for 24 to 48 hours after treatment.
Treatment Options 2-Wet combing : Mechanical removal of lice by wet combing is an alternative treatment for patients who are too young for pediculicide treatment or who desire to avoid pediculicide therapy. Administration • Combing is performed with a fine-toothed comb; the hair should be wet, with an added lubricant such as hair conditioner. • Combing is done until no lice are found in each session, with repeat sessions every three to four days for several weeks.
Treatment Options 3-Oral ivermectin : Oral therapy is occasionally required for refractory infestations. • Ivermectin interferes with neurotransmission in arthropods and helminths, leading to paralysis and death. Administration Dose regimens used for pediculosis capitis have included a single 200 or 400 mcg/kg dose, usually repeated after 7 to 10 days or repeated at this point if live lice remain visible.
School & Household Recommendations • Children should not be excluded from school for lice and should avoid direct head contact with other individuals. • Household members should be examined and treated if needed. • Vacuuming furniture and floors can help remove loose hairs with nits. • Wash hair care items and clothing used by the infested person in hot water and dry on high heat (at least 130°F).
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