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A n infestation of the scalp by the head louse

deposits its eggs on hair.

Feeds on scalp and neck and

Presence of head lice is associated with few symp- toms but much consternation.
• Epidemics in schools; classrooms are the main source of infestations. • Head
lice can survive off the scalp for up to 55 h.
Incidence M ost common
pediculosis. Esti- mated that 6–12 million persons in the United States are infested
annually. Bordeaux, France: up to 49% of schoolchildren. Jerusalem, Israel: 20% in
1991. Bristol, UK: 25% in 1998. Ilorin, Nigeria: 3.7% in 1987.
Skin Symptoms • Pruritus of the back and sides of scalp. • Scratching and
secondary infection associated with occipital and/or cervical lymphadenopathy.
Psychiatric Symptoms
Some individuals exhibit obsessive compulsive disorder or
de- lusions of parasitosis after eradications of lice and nits.
Skin Findings
Infestation • Head lice are identified by eye or with hand lens but are difficult to
find (Fig. 28-11 A ). • Most patients have a population of <10 head lice. • Nits
are the oval grayish-white egg capsules (1 mm long) firmly cemented to the hairs
(Fig. 28-11 B) ; vary in number from only a few to thousands. • Nits are
deposited by head lice on the hair shaft as it emerges from the follicle. With
recent infestation, nits are near the scalp; with infestation of long standing, nits may
be 10–15 cm from the scalp. • I n that scalp hair grows 0.5 mm daily, the
presence of nits 15 cm from the scalp indi- cates that the infestation is
approximately 9 months old. • N ew viable eggs have a creamy-yellow color;
empty eggshells are white. • Sites of predilection: Head lice nearly always
confined to scalp, especially occipital and postauricular regions. Rarely, head lice
infest beard or other hairy sites. Although more common with crab lice, head lice
can also infest the eyelashes ( pediculosis palpebrarum ).
S kin Lesions • Bite
reactions at site of louse bites apparent on neck. Phases related to immune
sensitiv- ity/tolerance:
Phase I: no clinical symptoms.
Phase II: papular
urticaria with moderate pruritus.
Phase III: wheals immediately following bite
with subsequent delayed papules/intense itching. P hase IV: smaller papules with
mild pru- ritus.
• Eczema, excoriation, lichen simplex chronicus on occipital
scalp and neck secondary to chronic scratching/rubbing. • Secondary
impetiginization with S. aureus of eczema or excoriations; may extend onto neck,
forehead, face, ears. • Confluent, purulent mass of matted hair, lice, nits,
crusts, and purulent exudation in extreme cases. • Pediculid is a
hypersensitivity rash, resem- bling a viral exanthem. • Wood lamp: Live nits
fluoresce with a pearly fluorescence; dead nits do not.
Regional Lymph Nodes P
ostoccipital lym- phadenopathy secondary to impetiginization of excoriated sites.

shampoo). • F amilies should look for lice routinely.” page 860. upholstery. duration/ technique of combing. fre. hair lacquer.quency.g. Louse comb increases chances of finding lice. Many schools in the United States adhere to a "no-nit" policy before children can return after infestation. hair brushes. • B edding. white piedra ( T. clothing. psychogenic itch. and thoroughness. °° ° ° LABORATORY EXAMINATIONS Microscopy The louse or a nit on a hair shaft (Fig. incomplete ovicidal activity.Small White Hair “Beads” Hair casts (inner root sheath remnants). 28-11 B ) can be examined to confirm the gross examination of the scalp and hair. inap. live eggs not removed.5-mm oval. clothing. the hair is wet-combed with a finetoothed comb to remove nits. combs. translucent grayish-white body that is red when engorged with blood. reinfestation. failure to re-treat. DIAGNOSIS Clinical findings. dandruff (epidermal scales). and head gear should be washed and dried on the hot cycle of a dryer. misdiagnosis. • C ombs and brushes should be soaked in rub. Nits within 4 mm of scalp suggests active infestation. No Infestation Delusions of parasitosis. bac. headsets. inkin ) Scalp Pruritus Impetigo.propriate instructions on head-lice products or from health professionals. visualized with a lens. B. insufficient dose-time. Causes of Therapeutic Failure Misunder. MANAGEMENT Fomite/Environmental Control • Avoid contact with possibly contaminated items such as hats. Complete nit removal depends on comb structure. Removal of Nits After treatment and neutral shampoo. SECTION 28 ARTHROPOD BITES. an egg with a developing head louse.terial cultures should be obtained. Culture If impetiginization is suspected. noncompliance. and/or quantity of product applied. Louse Insect with six legs. Under a microscope. Pediculocide Therapy See “Management. Nits alone are not diagnostic of active infestation.tion these have a bottle shape. acquired resistance to insecticides.. Nits 0 . AND CUTANEOUS INFECTIONS 863 FIGURE 28-11 Pediculosis capitis: multiple nits on scalp hair A. On close examina. • The environment should be vacuumed. lichen simplex chronicus. attached to a hair shaft. bedding. inappropriate preparation (e. STINGS. high cost of products.standing of alcohol or Lysol 2% solution for 1 h. wingless. towels. . hair gels. black piedra (Trichosporon ovoides) . 1–2 mm in length. whitish eggs. is seen. Nonviable nits show an absence of an embryo or operulum. confirmed by detection of lice. Arrows: grayish-white egg capsules (nits) are firmly attached to the hair shafts.

or physostigmine ophthalmic preparations applied twice daily for 1 or 2 days. followed by removal of nits. (Eyelash infestation common with pubic lice.) Secondary Bacterial Infection S hould be treated with appropriate doses of oral antimi. .O vernight application of petroleum jelly or HairClean 1-2-3 may facilitate removal of nits.crobial agent. Pediculosis Palpebrarum Apply petrolatum to lashes twice daily for 8 days.