Pediculosis Capitis

Hervina, Betania

*Departement Of Dermatology and venereolgy

Faculty of Medicine Methodist University of North Sumatera
**Departement Farmacology Faculty of Medicine Methodist University of North
Sumatera

ABSTRACT

Pediculosis is a skin or hair infection in humans caused by Pediculus humanus var.

capitis.1,2 This disease mainly affects young children and is rapidly expanding in a dense
environment. Head lice are spread throughout the world, and head lice infections are common
in developed and developing countries. The way of transmission is usually through
intermediaries (objects), such as combs, pillows, mattresses, and hats.1 most surveys show
girls suffer more often than boys. The dominant initial symptoms are only itching, then due to
scratching, erosion, escalation, and secondary infection (pus, crusting). If the secondary
infection is severe, the hair will clot due to the large number of pus and crusts (plikapenolika)
and accompanied by enlargement of regional lymph nodes (occiput and retroauricular).
The exact diagnosis of pediculosis is to find lice or eggs, especially sought in the
occiput and temporal regions.1Permethrin is the main therapy used in Pediculosis which
contains
syntheticpyretoid which has the use of killing the parasite. Besides permethrin there is also
0.5% Malathion and ivermectin.
Keyword: PediculosisCapitis
INTRODUCTION ETIOLOGI

Pediculus humanus var. capitis.14

Pedikulosis is an infection of the skin or

hair in humans caused by Pediculus

(classified family Pediculidae). In addition

EPIDEMIOLOGY
to attacking humans, this disease also

attacked an animal, therefore differentiated This disease mainly strikes children of

Pediculus humanus with Pediculus young age and quickly extends in a dense

animalis. Pediculus is an obligate parasite, environment, for example in the

this means having to suck the blood of dormitories and orphanage. Moreover in

human beings to be able to sustain life. 1 the facility's conditions are not good, for

example, rarely clean hair or hair that is

Classification of Pedikulosis i.e. Pediculus
relatively difficult to clean up (long hair on
humanusvar. capitis which caused
a woman). The way of transmission is
pedikulosiskapitis, Pediculus humanus
usually through an intermediary (objects),
var. corporis that cause pedikulosis
such as Combs, pillows, mattresses, and
korporis, Phthirus pubis that cause
1
hats.1
pedikulosis pubis.

Head lice are spread around the world, and

DEFINITION
head lice infection is common in
Pedikulosiscapitis is a skin and head hair
developed countries or developing
infection caused by Pediculushumanus var.
countries. In the United Kingdom, at the
capitis.1.2
time of the past, head lice commonly adults, and most surveys show more girls

found in industrial cities. On the industrial often suffer than boys. Habits in girls and

cities in the year 1941, about 40% of boys boys at different ages affects the numbers

ages preschool and 50% girls have head of infections. For example, in elementary

lice. In contrast, the number of infections school, contact between the head and often

in rural communities tend to be low. A occurs more often in girls. While the older

survey on school children in 1975 showed children are generally more independent

that most of the prevalence of 2.44% of and also often with separate friends doing

sufferers, the highest number of obtained so. Long hair also have contributions. A

on areas with a high population density. So survey in Israel found the number of

found the number of infections is higher in infections is higher in children with long

urban areas than rural areas. Nevertheless, hair and short hair compared to the

in the early 1980 's, the infection appear medium.2.3

particularly on middle-class group. Often

It is thought that the majority of head lice
in families who work, especially the rural
infection acquired through direct contact
and suburban areas. Since then, in the last
heads, optimal conditions when hair and
few years, head lice can not be classified
adjacent displacement takes place slowly.
in group classes and spread all over the
The spread of head lice is supported by a
world. A survey conducted in Jordan
factor of poverty, bad hygiene, and
becomes interesting when it was
excessive density. Excessive density
discovered the relationship between the
becomes an important factor. Do not
infection rate high on the socio-economic
terjaganya own hygiene encourage
2
class.
infection head lice. There are many

Common head lice in children, especially opinions regarding the displacement of

in the age range 3-11 years, compared with head lice and allegedly related to hats,
scarves, combs, and brushes are hard to Head lice is the most frequent among the 3

justified or report.2 species of louse (head lice, body lice, head

lice and genital). The average length of

ETIOPATOGENESIS
head lice that is 1-2 mm. Tick females are
Human Fleas including the phylum
generally larger and numerous compare
Arthropoda, Class Insecta, Phthiraptera,
head lice males. Lice have no wings and
group and Anoplurasubgolongan (known
are white to gray, flat dorsoventralnya, and
as head lice MacGregor).Mammals
part of the abdomen that is bersegmen.
ishospes for entire Anoplura. Anoplura
This mite have 2 eyes, 3 pairs of legs with
didn't have wings and had 3 pairs of legs
claws. The average life time of 30 days.1.4
with each end there are claws for grasping.

The size and shape of the claws adapted to

the texture and shape of the hair and

clothing fibers or that their handheld. Body

lice are flat and covered by a hard chitin. 4

The bug is k an insects blood. Human fleas

have a small front part of the mouth with 6 Image 1. Pediculus humanus capitis

hooks that help perlekatannya on human

Pediculus humanus capitis, has an
skin during meals. Suction mouth part
elongated body and narrow anterior mouth
attracted to the head when the head lice are
section. Body lice look similar to head
not being fed. Generally head lice eat
lice, but they lay their eggs on cloth fibers,
approximately 5-6 times per day. On every
not on hair fibers. Adult female lice
tick of the species, females have a larger
produce eggs and attach them to the base
4.5
size than the male tick.
of the hair by producing a glue-like

substance from their reproductive organs.

Eggs are placed 1-2 mm in the scalp, reaching its adult form. Adult head lice

where the temperature is optimal for only last 1-2 days without the host. Adult

incubation. Female lice spawn as many as lice reproduce sexually. Males will die

10 eggs per 24 hours, usually at night. The after copulation.

typical location of the egg is in the back of

the head and postauricular area.

Image2. Life cycle of pediculus humanus capitis

Its life cycle through the stages of eggs,

larvae, nymphs, and adults. The egg is

placed along the hair and following the Image3. (a) filled eggs and (b) broken eggs3,4

growth of hair, which means that the more

Infestations by head lice spread physical
end there is more mature. Eggs measuring
contact and use with items (such as combs,
0.3 to 0.8 mm, yellow to white. The eggs
brushes, hats, scarves and blankets). Lice
hatch on the 8-9th day if they stay close to
can come out using combs, towels and air
body temperature and mature on the 9th-
movement (including hair dryers).
12th day. Eggs can last up to 10 days
Combing hair and wiping sweat can
without a human host. Lower temperatures
remove adult lice more than 1 meter from
slow down hatching and development. The
the infested scalp. Head lice can run up to
nymph changes the skin 3 times before
23 cm per minute. Head lice are hard to secondary infections associated with

stick to smooth surfaces (eg glass, metal, occipital or cervical lymphadenopathy.

plastic, and synthetic feathers). While psychiatric symptoms that arise are

Itching arises because of the inflammatory in some individuals experience obsessive

response of the sensitized host with flea compulsive disorder or understanding of

antigens such as saliva and excreta from the presence of parasites after the

fleas that enter the skin when sucking destruction of fleas and lice eggs.3

blood. Skin disorders that arise by

On examination of the skin found
scratching to relieve itching.
infestations, namely:3

- Head lice that are identified directly

CLINICAL SYMPTOMS.
with the eye or with the help of a
The dominant symptoms are only itching,
magnifying glass.
especially in the occiput and temporal
- Most patients have a flea population of
areas and can extend to the entire head.
less than 10.
Then because of scratching, erosion,
- Lice eggs are gray to white oval
escalation, and secondary infection (pus,
capsules and firmly attached to the
crusting). If the secondary infection is
hair. The amount varies from several to
severe, the hair will clot due to the large
thousands.
number of pus and crusts (plika penolika)
- Lice eggs are placed by head lice at the
and accompanied by enlargement of
base of the hair. In the initial
regional lymph nodes (occiput and
infestation, the egg is placed close to
retroauricular). In this condition the head
the scalp, but if the infestation is long
1
gives a bad smell.
the egg is located 10-15 cm from the

Symptoms of the skin are pruritus in the scalp.

back of the scalp, scratching and

- Because hair grows by 0.5 mm per then followed by papules or severe

day, the location of the 15 cm lice from itching.

the scalp shows that the infestation has

Phase IV: smaller papules with
lasted for 9 months.
moderate itching.
- The new egg is brownish yellow, while
- Eczema, eschoriation, and
the empty eggshell is white.
neurodermatitits on occipital scalp and
- Predilection of head lice is always
neck due to chronic scratching.
limited to the scalp, especially the
- Secondary impetigo by Staphylococcus
occipital and postauricular regions.
aureus from esoriation in the neck,
Infrequently head lice can infest beards
forehead, face and ears.
and other haired places. But sometimes
- Confluent and purulent mass of hair
head lice are infested with eyelashes
that has tangled hair, lice, crusting, and
(pediculosis palperbrarum).
exudation in extreme cases.
Lesions can also occur on the skin such
- Pediculoside causes hypersensitivity
3
as:
red spots.

- Bite reactions at the bite of the lice in - Lampu wood: eggs that are still alive

the neck. Phases related to immune with efflorescence like diamonds.

sensitivity or tolerance, namely: While dead eggs do not have

efflorescence.
Phase I: no clinical symptoms.

Postoccipital lymphadenopathy also occurs

Phase II: papularurticaria with
due to impetigo and eschoriation.3
moderate pruritus.

Phase III: urticaria which is

immediately after the bite which is

 helper screening tool. The diagnosis of

fleas using this flea comb is four times

more efficient than direct visual

examination.6,7

Eggs are easier to observe, especially at

the nape of the neck or behind the ears.

The discovery of eggs alone is not a

diagnosis for active infestations. However,

if the egg is found within 0.7 cm of the

scalp, active infestation may occur. Wood

lights and magnifying lenses can be used

Image4. Clinical manifestations of pediculosis

kapitis6 to help diagnose. Dermoscopy is also an

DIAGNOSIS aid in the diagnosis and follow-up of

pediculosis kapitis.6,7
The most diagnostic way is to find fleas or

eggs, especially in the occiput and Dead eggs can remain behind the hair for 6

temporal months. Human hair grows at a rate of

around 1cm per month. Because it comes

regions. The eggs are gray and shiny.1
with growing hair, empty lice eggs that
To diagnose fleas, look for lice or eggs
have attached to the strands of hair will
that are appropriate (nits) on examination.
move away from the scalp. After 2 to 3
Eskoriasis and pyoderma can also be seen.
months, empty lice eggs become more
Because fleas avoid light and crawl
visible, especially in dark hair.7
quickly, visual inspection without combing
Investigation through a microscopic
is difficult. Using a flea comb increases
laboratory examination of lice or egg lice
the possibility of finding live lice and is a
on hair strands can be examined to confirm

the macroscopy of the scalp and hair.

Culture can be done if suspected of

impetigation, bacterial culture is needed3

DIFFERENTIAL DIAGNOSA

Judging from the clinical manifestations of

small lumps such as pearls in the hair can
be diagnosed with a comparison with
black pyedra and white pyedra. Piedra
black is a Piedraia hortae fungal infection,
while white pyedra is caused by the genus
Trichosporum in hair which results in
lumps outside the surface of the hair. In
the black pyedas dark pigmented nodules
feel hard and firmly adhere to the hair. On
Image 5. Black axis on microscopic
examination2
Folliculitis is inflammation or
inflammation of hair follicles that can be
caused by infection, chemical irritation or
physical injury. Inflammation can occur on
the surface or superficial even in deeper or
deeper parts of the hair follicle. Folliculitis
is a problem that is often found among
various types of inflammatory diseases of
the skin

white pyedra, the pigmented nodules are

bright and easily detached from the hair. In

addition, it also causes hair to break easily,

but the skin around is healthy. On pyedra it

is often asymptomatic, but pruritus is the

image 7. Head Folikulitis
3,8,9
main symptom.
Seborrheic dermatitis is a chronic skin
disease, and often recurs. Seborrheic
dermatitis is included in the group of
erythrockuamose dermatoses which is a
skin disease characterized by erythema and
squares. Seborrheic dermatitis is often
confused with psoriasis which is also
included in the group of erythroskuamosa
dermatoses. The cause is uncertain, some
theories explain etiopathogenesis
TREATMENT
A. Pharmacology
The pharmacologi treatment of head lice
infestation is focused on two mechanisms,
namely neurotoxicity which causes lice
paralysis, and makes lice not breathe by
"coating" the lice. Most clinical trials use
substances that are neurotoxic through
topical products. Treatment aims to
destroy all lice and eggs and treat
secondary infections.1,6
Permethrin (1%) is a first-line treatment
for pediculosis. Permethrin (1%) is a
topical insecticide that is neurotoxic in
head lice. This substance is used in the hair
after washing with shampoo without
conditioner and dried with a towel. This
pediculoside is left for 10 minutes then
rinsed. Permethrin kills live lice but not
hatched eggs. Reuse is recommended on
days 7-10 if live lice are still visible.
Experts recommend routine treatment
again on the 9th day. Permethrin (1%) is
allowed for use in children aged 2 months
or more.4,6,10
0.5% Malathion is an organic phosphate
compound that has proven to be more
effective than permethrin, has a high lethal
effect, and decreases the number of
repeated infestations if used appropriately.
Its use is permissible for individuals aged
6 years or more. Preparations in the form
of lotion or spray. How: the night before
going to bed, the hair is washed with soap,
then used lotion malathion, then the head
is covered with a cloth. The next day the
hair is washed again with soap and
combed with a smooth and tightly combed
comb. In addition, you can apply this
substance to dry hair, sprayed until the hair
and scalp are quite wet. This treatment can
be repeated a week later, if there are still
fleas or eggs. This substance is flammable,
so it is not recommended to do activities
such as using a hair dryer, smoking, or lactating women. The use of lindane

close to the source of fire when the hair is should be avoided unless all treatments are

still wet. The drug is difficult to obtain.1,4,6 contraindicated or ineffective. Repeated

use is not recommended in any situation.

Pyretrin with piperonylbutoxide
How to use it: after applying it, then let it
(PBO).Pyretrin is a derivative of
stand for 12 hours, then wash it and comb
chrysanthemums extract, while PBO
it with a comb so that all lice and eggs are
synergizes with pyretrin. This substance
released. If there are eggs, a week later is
can kill flea mites and their eggs. Pyretrin
repeated the same way. Another drug is
is a topical insecticide that is neurotoxic to
the 25% benzyl benzoate emulsion, used in
head lice. The use of pyrethrin should not
the same way. In Indonesia this drug is
be given to individuals who are allergic to
easily obtained.1,3,6
chrysanthemums or grass. Liquid

preparations, gels and shampoo. Oral ivermectin is a systemic anti-parasite

Substances are applied to dry hair for 10 that shows effectiveness in clinical trials,

minutes before rinsing. Treatment is but is not a recommendation from the

repeated in 7-10 days in order to kill the Food and Drug Administration (FDA) for

newly hatched nymphs that pass the initial the treatment of pediculosis. The dose is

treatment.3,4,6,10 200-400 μg / kgBB on days 1 and 8 (total

2 doses). Not recommended for use in

Lindane 1% (gamma benzene
children weighing less than 15 kg, in
hexachloride / gammexane) has been
pregnant and lactating women. Side effects
warned of its use because of its
that generally arise in the form of dizziness
neurotoxicity effect. Lindane can be used
and itching.6
as a second line in adults, but cannot be

used in children, elderly people, and adults In the case of severe secondary infection,

weighing less than 50 kg, pregnant and hair should be shaved, secondary infection
treated with systemic and topical who share a bed with an infested

antibiotics. Then followed by the drug individual, even though no live lice have

above in the form of shampoo. Hygiene is been found on him. Transmission with

a requirement so that residif does not goods is lower than direct transmission

occur.1 with head contact. However, you should

clean the hair tool used by patients with

B. Nonpharmacology
pediculosiskapitis. A study showed that
There is no effective 100 percent
head lice can move through the pillow at
pediculoside, manual removal of fleas
night, but the incidence is low at around
(especially those located 1 cm from the
4%. Changing sheets can minimize the risk
scalp) after treatment with a product is
of flea transmission. Only items that are
recommended. Manual removal is difficult
affected by the head of the patient within
and boring. Simple comb assistance can
24-48 hours before treatment are
simplify the process. A study shows that
considered for cleaning, see the fact that
manual removal with a comb can hurt fleas
there are rarely ticks that survive more
and rarely will survive. Wet hair slows
than 48 hours if separated from the scalp.
down the lice. We recommend that
Some items such as clothing, hats,
sweeping be done every 3 days for 2
furniture, and carpets, with washing,
6,11
weeks.
soaking, or drying with a temperature of

If a person is identified with head lice, all more than 130 ° F will kill the fleas and

family members should be examined for eggs. Furniture, carpets, car seats and cloth

possible head lice. Individuals with live items can be cleaned with a vacuum

lice or eggs within 1 cm of the scalp cleaner. While items that cannot be

should get treatment. In addition, treatment washed should be wrapped in plastic for 2

should also be given to family members

weeks to prevent the nymphs from infection is greater than the physical

hatching for food sources11 impact caused by flea infestations.

Sensitive reactions to saliva and flea feces

can cause local irritation and erythema.

Secondary infection due to scratching may

occur. Mites have been identified as the

main mechanical vectors of pyoderma on

Images10, comb your hair with
the scalp caused by streptococcus and
a crescent comb11
staphylococcus which are usually found on
COMPLICATIONS
the skin. A good prognosis if hygiene is
Secondary infections by bacteria can occur
observed.1,13
with pediculosiscapitis. In fact, head lice

are thought to be the most common cause

of pyoderma on the scalp. Head lice can

host host to rickettsiae and have potential

for disease transmission. In laboratory

experiments, head lice were infected with

Rickettsia prowazekii. In addition,

Bartonellaquintana is also the cause of

trench fever.12

PROGNOSIS

This infestation is basically harmless.

However, the stigma associated with head

lice and psychological trauma experienced

by some people in its efforts to eliminate

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