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Lice may infest the head (Pediculus humanus capitis), the body (P. humanus corporis), or the genital area (Phthirus pubis). Elderly people who have poor personal hygiene or who live in an overcrowded environment are at risk for head and body lice.
Pediculosis capitis is spread by personal contact or by sharing hairbrushes and head wear. The patient develops severe scalp itching, often with secondary eczematous changes and impetiginization. Cervical lymphadenopathy may occur. Examination reveals small gray-white nits (ova) on the hair shafts. Unlike scales, they cannot be easily removed. Adult lice are not usually found.
Pediculosis corporis produces intense generalized itching. The patient frequently develops eczematous changes, severe excoriations, and a secondary bacterial infection. Lice or nits may be found in the seams of the patient’s clothing.
Pediculosis pubis is usually spread by sexual contact but can be transferred by clothing or towels. The base of pubic hairs should be carefully searched for lice and their eggs. Sometimes, dark brown particles (louse excreta) may be seen on underclothes.
Treatment: For head lice, shampoo containing lindane 1% is applied to the scalp, left in place for 4 min, and rinsed off. The patient should then comb the hair with a fine-tooth comb. The procedure should be repeated in 10 days to destroy any remaining nits. Combs and brushes should be soaked in the shampoo for 1 h.

For body lice, the patient’s clothing should be boiled, dry-cleaned, or machine washed with hot water. The seams of the clothing should be pressed with a hot iron. Alternatively, the clothing can be disinfected with an insecticidal powder such as DDT 10% or malathion 1%. Because lice do not remain on the host after feeding, the patient’s skin requires therapy only for irritation and pruritus.
For pubic lice, 1% lindane shampoo is applied to the pubic area for 4 min, then rinsed off. This treatment should be repeated in 10 days.

Tags: Pediculosis (Lice)

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