Pediculosis

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Pediculosis
Pediculosis is an infestation of the hairy
parts of the body or clothing with the eggs,
larvae or adults of lice.
The crawling stages of this insect feed on
human blood, which can result in severe
itching.
Head lice are usually located on the scalp,
crab lice in the pubic area and
body lice along seams of clothing.
 Epidemiology And Etiology
Etiology :
Lice

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Three types of lice:
• Head lice: Pediculus humanus
capitis (2-3 mm long)

• Body lice: Pediculus humanus

humanus (2.3-3.6 mm long)

• Pubic lice (crabs): Phthirus

pubis (1.1-1.8 mm long)

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Head Lice Body Lice Pubic Lice

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 Transmission
➢Direct contact between individuals.

➢Indirect contact with bedding, brushes, or

clothing, according to species.

➢ Pediculosis and scabies may coexist in

the same individual

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Secondary Infections of Excoriated Sites
➢Excoriation may become secondarily
infected with S. aureus , GAS.
➢Infection can extend, resulting in cellulitis,
lymphangitis, and/or bacteremia

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 Clinical Manifestation

• Pruritus occurs in a variable

proportion.

• Excoriations can become secondarily

infected.

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 Pediculosis
Pediculosis may be divided into the
following types :
1)Pediculosis capitis
2)Pediculosis corporis
3)Pediculosis pubis

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 Pediculosis Capitis
• An infestation of the scalp by the head
louse.

• Feeds on scalp and neck and deposits its

eggs on hair.

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 Epidemiology And Etiology
• Etiology :

The subspecies Pediculus humanus capitis

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 Epidemiology And Etiology
• Sex, Age of Onset:
Girls > boys. 3–11 years, but all ages.

• Race:
In United States, more common in whites
than blacks

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 Transmission

1) Head-to-head contact.
2) Shared hats, caps, brushes, combs;
theater seats; pillows.
3) Epidemics in schools; classrooms are the
main source of infestations.
4) Head lice can survive off the scalp for up
to 55 h.

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 Predisposing Factors

• School-age children and their mothers.

• More common in warmer months.

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 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 ).

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Pediculosis capitis: multiple nits on
scalp hair

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Diagnosis
1) Clinical Diagnosis (Skin lesion )
2) Laboratory Examinations :
•Microscopy : The louse or a
nit on a hair shaft
• Cultures :. If impetiginization is
suspected, bacterial cultures should
be obtained.

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Management
1. 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 check for lice routinely.Page 18
 2. Pediculocide Therapy

• 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 after 10 min of exposure.
• Permethrin are synthetic pyrethoids widely
used as insecticide, araricide, and insect
repellant.
→Lotion preparations are preferred; creams, foams,
gels are also available.

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Alternative Regimen :
➢Lindane 1% shampoo :
• Applied for 4 min and then thoroughly
washed off.
• (Not recommended for pregnant or
lactating women.)

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Alternative Regimen :
➢ Ivermectin :
0.8% lotion or shampoo.

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• Systemic Therapy:

Oral ivermectin : 200 μg/kg; repeat

on day 10 to kill emerging nymphs.

• oral ivermectin in cases of resistance

to both pyrethroids and malathion
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 Pediculosis Corporis
• In body louse infestations, lice reside and
lay eggs in clothing.
• Leave clothing to feed on human host .
• Body louse survive more than a few hours
away from the human host.
• Occurs in poor socioeconomic conditions.

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 Epidemiology And Etiology
Etiology :
Pediculus humanus humanus.

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Risk Factors :

1. Poor socioeconomic conditions.

2. when clothing is not changed or washed

frequently: poverty, war, natural
disasters, indigence, homelessness,
refugee-camp populations.

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Pediculosis corporis. Severely malnourished, ill-kept,
homeless male with multiple excoriations, erosions and crusted
papules, and nodules and eczematized lesions. Lice and nits are
seen in the seams of clothing (inset).

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Diagnosis :

Lice and eggs are found in clothing

seams.

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 Management
• Bedding and clothing must be
systematically decontaminated.

• Hygiene Measures
→Basic sanitation measures, and
→hygiene measures to assure changes of
clean clothing, body washing, and sometimes
shaving.

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 Management
• Delousing:
➢ Pyrethrins / pyrethroids or malathion for 8–
24 h is recommended in some cases.
➢ Outbreaks necessitate delousing of individuals
with 1% permethrin dusting powder .
• Louse-Borne Infections: Antibiotics are
indicated if louse-borne infectious disease
(trench fever, epidemic typhus) exists.

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 Pediculosis Pubis (Pthiriasis)
Crabs
➢ Sexually transmitted disease.
➢ Pediculosis pubis is an infestation of hair-bearing
regions:
▪ Most commonly the pubic area
▪ Hairy parts of the chest and axillae
▪ Upper eyelashes.
➢ Manifested clinically by mild to moderate
pruritus, papular urticaria, and excoriations.

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 Epidemiology And Etiology
• Age :Most common in young adults;
range, from childhood to senescence.
• Sex: More extensive infestation in males.
• Etiology :
Pthirus pubis

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 Transmission

1) Close physical contact: sharing bed;

possibly exchange of towels.
2) Sexual exposure. May coexist with
another sexually transmitted infection
(STI).
3) Nonsexual transmission: homeless
persons who have pubic lice in hair on
head and back.

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Clinical Manifestation
➢ Often asymptomatic.
➢ Mild to moderate pruritus for months.
➢ Patient may detect a nodularity to hairs (nits or
eggs) while scratching.
➢ With excoriation and secondary infection, lesions may
become tender and be associated with enlarged
lymph node in the inguinal region.

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 Skin Lesions
•Papular urticaria (small erythematous papules) at
sites of feeding, especially periumbilical ; blisters.

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• Secondary infection: detected in patients
with significant pruritus.

• Maculae ceruleae ( taches bleues ): are

slate-gray or bluish-gray macules 0.5–1 cm in
diameter, irregular in shape, nonblanching.
Pigment thought to be breakdown product of
heme affected by louse saliva.

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• Eyelash infestation :
Serous crusts may be present along with
lice and nits , occasionally, edema of eyelids
with severe infestation.

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 Laboratory Examinations

• Microscopy Lice (Fig.) and nits may be identified

and differentiated from head/body louse with hand lens
or microscope.

• Cultures Bacterial cultures of impetiginized

excoriation
• Serology Sexually transmitted. Testing for other STIs
may be indicated in some individuals.

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 Management
1. Prevention:
Patient and sexual partners should be
treated.
2. Use of Pediculocides

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