Pediculosis Capitis

Yuni Eka Anggraini

Epidemiology and Etiology
• The subspecies Pediculus humanus capitis , Sesame
seed size, 1–2 mm.
• Feed every 4–6 h.
• Move by grasping hairs close to scalp; can crawl up to
23 cm/day.
• Lice lay nits within 1–2 mm of scalp.
• Nits are ova within chitinous case. Young lice hatch
within 1 week, passing through nymphal stages,
growing larger and maturing to adults over a period of 1
week.
• One female can lay 50–150 ova during a 16-day lifetime.
• Survive only for a few hours off scalp.
...cont’d

• Vector of Infection Head louse is not a vector of infectious disease.

• Sex, Age of Onset Girls > boys. 3–11 years, but all ages.
• Predisposing Factors School-age children and their mothers. More
common in warmer months
Clinical Findings
• 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 delusions
of parasitosis after eradications of lice and nits.
• Skin Findings
• Infestation
• Head lice are identified by eye or with handlens but are difficult to
find
• Most patients have a population of <10 headlice.
• Nits are the oval grayish-white egg capsules (1 mm long) firmly
cemented to the hairs
• vary in number from only a few to thousands.
• with infestation of long standing, nits may be 10–15 cm from the
scalp.
• Skin Lesions
• Bite reactions at site of louse bites apparent on neck. Phases related to immune
sensitivity/tolerance:
1. Phase I: no clinical symptoms.
2. Phase II: papular urticaria with moderate pruritus.
3. Phase III: wheals immediately following bite with subsequent delayed papules/intense
itching.
4. Phase IV: smaller papules with mild pruritus.
• Eczema , excoriation , lichen simplex chronicus  chronic scratching/rubbing.
• Secondary impetiginization with S. aureus of eczema or excoriations; may extend onto
neck, forehead, face, ears.
• Confluent, purulent mass  purulent exudation inextreme cases.
• Pediculid is a hypersensitivity rash, resembling a viral exanthem.
• Wood lamp : Live nits fluoresce with a pearly fluorescence; dead nits do not.
Laboratory Exam
• Microscopy The louse or a nit on a hair shaft
• Nits 0.5-mm oval, whitish eggs. Nonviable nits show an absence of an
embryo or operulum.
• Louse Insect with six legs, 1–2 mm in length,wingless, translucent
grayish-white body that is red when engorged with blood.
• Culture If impetiginization is suspected
Treatment
• Fomite/Environmental Control
• Avoid contact with possibly contaminated items such as hats,
headsets, clothing, towels, combs, hair brushes, bedding, upholstery.
• The environment should be vacuumed.
• Bedding, clothing, and head gear should be washed and dried on the
hot cycle of a dryer.
• Combs and brushes should be soaked in rubbing alcohol or Lysol 2%
solution for 1 h.
• Families should look for lice routinely.
• Topically Applied Insecticides
• Ideally, should have 100% activity against louse and egg.
• Malathion kills all lice after 5 min of exposure, and >95% of eggs fail
to hatch after10 min of exposure.
• Permethrin are synthetic pyrethoids widely used as insecticide,
araricide, and insect repellant.