Head lice is also known as Pediculosis capitis. Lice are tiny, parasitic insects and their infection in the scalp affects many people globally every year. In fact, it takes place in every socioeconomic class and all countries. Lice are parasitic and obligate insects and have no-free living phase in their life cycle. They are transferred by fomite-skin contact or by direct skin-to-skin contact and symptoms usually develop three to four weeks after the initial infestation. Three species of lice that spread in human beings are Pthirus pubis (crab or pubic louse), Pediculus humanus (body louse), or Pediculus humanus capitis (head louse). Head louse is most prevalent and infests people of all classes, while body lice infest more often among displaced and homeless people. Infestation by body lice must be suspected in such people, as in the presence of cold weather, bad hygiene and scratching.
Epidemiology
Very few publications exist on pediculosis. Head louse affects six to twelve million people annually in the United States, the exact number is unknown because it is not a reportable condition. Infestation with head lice is more prevalent in children between 3 to 12 years, with a greater predominance in girls than in boys. In industrialized countries, small epidemics usually develop in school children with tight social bonds and several members of the same household may be affected. During warmer months, particularly in areas with increased humidity, the infestation with head lice occurs more frequently. Body lice are usual during the cold season and in individuals of high sexual activity. Further epidemiological studies on pediculosis are required to know it better for developing control measures.
Anatomy
Pathophysiology
Patients often get pruritis, which is primarily caused by a hypersensitivity reaction that is of the immune-mediated type. The period between the first exposure, which needs to be two and six weeks to show the symptoms is longer than maybe one to two days after repeated exposure pruritis can occur. The feeling of being itchy promotes scratching, which in turn leads to the development of secondary bacterial infections such as pyoderma and impetigo that might later progress to being very severe. Body lice has the ability to transmit epidemic typhus, trench fever, and relapsing fever in humans.
Etiology
Body lice and head lice are from 1 millimeter to 3 millimeters in length, while the pubic louse is so much smaller. The head louse is an obligatory parasite that spends its life on the human host. Head lice feed only on blood. Lice have no ability to jump or fly; they need close contact for transmission. The infestation of lice is considered to be transmitted by head-to-head contact, sharing headgear, or other direct contact with fomite. Pubic lice are spread by clothing and bedding or sexual contact. Body lice reside on and lay their eggs in bedding or clothing, only moving to the skin to feed. They mainly spread in people through direct contact where hygiene is not practiced well. However, they can be transferred by bedding, towels, and clothing also.
Genetics
Prognostic Factors
The prognosis for head lice is usually favorable. Medications are highly effective in destroying mature lice and nymphs if used correctly. Failures to treatment can occur due to several factors, including non-compliance with retreatment schedules, failure to eliminate live nits, lack of ovicidal activity, inappropriate usage of the pediculicide, insufficient environmental elimination, failing to treat close contacts, and drug resistance. While rare, some patients with body lice may come in contact with typhus, recurrent or relapsing fever or trench fever.
Clinical History
Children with head lice may be asymptomatic initially. However, itching limited to the scalp often develops as the first and most prominent symptom, and may become very severe. The louse cements its white-to-tan/gray, oval-shaped eggs, or nits, to hair shafts a few millimeters from the scalp, commonly behind the posterior and occipital auricular regions. Nits are more readily identified than adult crawling lice. Other possible symptoms of infestation by head lice include pyoderma without or with associated alopecia, fever, conjunctivitis, malaise, secondary impetiginization, occasional hypersensitivity eruption as diffuse morbilliform, and excoriation.
Physical Examination
The diagnosis of head lice is typically made by identifying live lice, either through combing wet hair or inspection of scalp. Visual inspection alone can be challenging, as lice move quickly avoiding light. While finding nits attached to hair shafts does not confirm active infestation, the presence of nits within 1cm of the scalp makes active infestation more likely. The diagnosis can sometimes be confirmed using a hand lens or microscope.
Age group
Associated comorbidity
Impetigo
Pyoderma
Epidemic typhus
Trench fever
Relapsing fever
Social embarrassment
Associated activity
Acuity of presentation
Differential Diagnoses
Seborrhea
Eczema
Scabies
Dandruff
Superficial fungal infection
Folliculitis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Successful treatment of Pediculosis capitis combines an integrated approach to diagnosis, medicamentation, mechanical removal, environmental decontamination control, education, prevention, monitoring of treatment response, and management of treatment failure. Treatment adherence, re-treatment when appropriate accompanied by follow-up is an essential step.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
modification-of-the-environment
Treatment of head lice also includes environmental modification. This would involve cleaning personal items; vacuuming furniture and floors; sealing non-washable items; using hair care tools; keeping away from hazardous insecticides; education of the contacts about the infestation; and regular examination of family members. Launder bedding, clothing, and the stuffed animals in hot water and dry on high heat for 20 minutes. Vacuum furniture and floors, especially around seams and crevices.
Use of Pyrethins
Pyrethin: It is a natural medicament extracted from chrysanthemum. It causes paralysis and neurotoxicity in head louse via interfering with Na+ transport. The half-life of the drug can be extended by adding piperonyl butoxide to pyrethins.
Use of pediculicides
Permethrin (1%): This is a synthetic pyrethroid and frequently indicated treatment which is applied topically. It is an OTC medication that acts by altering the transport of sodium across the neuronal membranes and causes respiratory paralysis in the lice.
Malathion: Â It is an inhibitor of cholinesterase belonging to the class of organophosphates. It eradicates head lice by causing paralysis in them. It is used as 0.5% solution.
Lindane 1%: This belongs to organochlorides and causes lysis of lice by causing respiratory paralysis.
Spinosad 0.9%: This is a pediculicidal agent which is used topically. It acts by inducing hyperexcitation leading to the death of the lice by paralysis.
Topical ivermectin (0.5%): This lotion raises the levels of chloride in the muscles leading to paralysis and hyperpolarization. This must be employed as a third-line treatment.
use-of-phases-of-management-in-treating-head-lice
The phases of management of head lice includes diagnosis, treatment, mechanical removal, education, prevention, etc.
Diagnosis:
This phase includes visual inspection and wet combing to detect lice.
Treatment:
Both over the counter and prescription treatments are available, with the latter being stronger.
Environmental control:
Decontaminate personal materials and seal un-washable items and, for therapy from the surroundings, vacuum areas.
Education:
Very important to educate or not sharing personal items, doing regular check-up, treating of contact and notify them for obvious infestations.
Recommended for use in the topical treatment of head lice infestation
Apply to dry hair in a quantity sufficient to completely cover the hair and scalp
Use as part of a comprehensive lice management programme:
Wash any recently used items, caps, used bedding, and towels in hot water or dry clean them
Wash personal care products in hot water, such as combs, brushes, and hair clips
Dead lice and nits should be removed with a fine-tooth comb or specialised nit comb
Recommended for use in the topical treatment of head lice infestation
Apply to dry hair in a quantity sufficient to completely cover the hair and scalp
Use as part of a comprehensive lice management programme:
Wash any recently used items, caps, used bedding, and towels in hot water or dry clean them
Wash personal care products in hot water, such as combs, brushes, and hair clips
Dead lice and nits should be removed with a fine-tooth comb or specialised nit comb
Head lice is also known as Pediculosis capitis. Lice are tiny, parasitic insects and their infection in the scalp affects many people globally every year. In fact, it takes place in every socioeconomic class and all countries. Lice are parasitic and obligate insects and have no-free living phase in their life cycle. They are transferred by fomite-skin contact or by direct skin-to-skin contact and symptoms usually develop three to four weeks after the initial infestation. Three species of lice that spread in human beings are Pthirus pubis (crab or pubic louse), Pediculus humanus (body louse), or Pediculus humanus capitis (head louse). Head louse is most prevalent and infests people of all classes, while body lice infest more often among displaced and homeless people. Infestation by body lice must be suspected in such people, as in the presence of cold weather, bad hygiene and scratching.
Very few publications exist on pediculosis. Head louse affects six to twelve million people annually in the United States, the exact number is unknown because it is not a reportable condition. Infestation with head lice is more prevalent in children between 3 to 12 years, with a greater predominance in girls than in boys. In industrialized countries, small epidemics usually develop in school children with tight social bonds and several members of the same household may be affected. During warmer months, particularly in areas with increased humidity, the infestation with head lice occurs more frequently. Body lice are usual during the cold season and in individuals of high sexual activity. Further epidemiological studies on pediculosis are required to know it better for developing control measures.
Patients often get pruritis, which is primarily caused by a hypersensitivity reaction that is of the immune-mediated type. The period between the first exposure, which needs to be two and six weeks to show the symptoms is longer than maybe one to two days after repeated exposure pruritis can occur. The feeling of being itchy promotes scratching, which in turn leads to the development of secondary bacterial infections such as pyoderma and impetigo that might later progress to being very severe. Body lice has the ability to transmit epidemic typhus, trench fever, and relapsing fever in humans.
Body lice and head lice are from 1 millimeter to 3 millimeters in length, while the pubic louse is so much smaller. The head louse is an obligatory parasite that spends its life on the human host. Head lice feed only on blood. Lice have no ability to jump or fly; they need close contact for transmission. The infestation of lice is considered to be transmitted by head-to-head contact, sharing headgear, or other direct contact with fomite. Pubic lice are spread by clothing and bedding or sexual contact. Body lice reside on and lay their eggs in bedding or clothing, only moving to the skin to feed. They mainly spread in people through direct contact where hygiene is not practiced well. However, they can be transferred by bedding, towels, and clothing also.
The prognosis for head lice is usually favorable. Medications are highly effective in destroying mature lice and nymphs if used correctly. Failures to treatment can occur due to several factors, including non-compliance with retreatment schedules, failure to eliminate live nits, lack of ovicidal activity, inappropriate usage of the pediculicide, insufficient environmental elimination, failing to treat close contacts, and drug resistance. While rare, some patients with body lice may come in contact with typhus, recurrent or relapsing fever or trench fever.
Children with head lice may be asymptomatic initially. However, itching limited to the scalp often develops as the first and most prominent symptom, and may become very severe. The louse cements its white-to-tan/gray, oval-shaped eggs, or nits, to hair shafts a few millimeters from the scalp, commonly behind the posterior and occipital auricular regions. Nits are more readily identified than adult crawling lice. Other possible symptoms of infestation by head lice include pyoderma without or with associated alopecia, fever, conjunctivitis, malaise, secondary impetiginization, occasional hypersensitivity eruption as diffuse morbilliform, and excoriation.
The diagnosis of head lice is typically made by identifying live lice, either through combing wet hair or inspection of scalp. Visual inspection alone can be challenging, as lice move quickly avoiding light. While finding nits attached to hair shafts does not confirm active infestation, the presence of nits within 1cm of the scalp makes active infestation more likely. The diagnosis can sometimes be confirmed using a hand lens or microscope.
Impetigo
Pyoderma
Epidemic typhus
Trench fever
Relapsing fever
Social embarrassment
Seborrhea
Eczema
Scabies
Dandruff
Superficial fungal infection
Folliculitis
Successful treatment of Pediculosis capitis combines an integrated approach to diagnosis, medicamentation, mechanical removal, environmental decontamination control, education, prevention, monitoring of treatment response, and management of treatment failure. Treatment adherence, re-treatment when appropriate accompanied by follow-up is an essential step.
Dermatology, General
Treatment of head lice also includes environmental modification. This would involve cleaning personal items; vacuuming furniture and floors; sealing non-washable items; using hair care tools; keeping away from hazardous insecticides; education of the contacts about the infestation; and regular examination of family members. Launder bedding, clothing, and the stuffed animals in hot water and dry on high heat for 20 minutes. Vacuum furniture and floors, especially around seams and crevices.
Dermatology, General
Pyrethin: It is a natural medicament extracted from chrysanthemum. It causes paralysis and neurotoxicity in head louse via interfering with Na+ transport. The half-life of the drug can be extended by adding piperonyl butoxide to pyrethins.
Dermatology, General
Permethrin (1%): This is a synthetic pyrethroid and frequently indicated treatment which is applied topically. It is an OTC medication that acts by altering the transport of sodium across the neuronal membranes and causes respiratory paralysis in the lice.
Malathion: Â It is an inhibitor of cholinesterase belonging to the class of organophosphates. It eradicates head lice by causing paralysis in them. It is used as 0.5% solution.
Lindane 1%: This belongs to organochlorides and causes lysis of lice by causing respiratory paralysis.
Spinosad 0.9%: This is a pediculicidal agent which is used topically. It acts by inducing hyperexcitation leading to the death of the lice by paralysis.
Topical ivermectin (0.5%): This lotion raises the levels of chloride in the muscles leading to paralysis and hyperpolarization. This must be employed as a third-line treatment.
Dermatology, General
The phases of management of head lice includes diagnosis, treatment, mechanical removal, education, prevention, etc.
Diagnosis:
This phase includes visual inspection and wet combing to detect lice.
Treatment:
Both over the counter and prescription treatments are available, with the latter being stronger.
Environmental control:
Decontaminate personal materials and seal un-washable items and, for therapy from the surroundings, vacuum areas.
Education:
Very important to educate or not sharing personal items, doing regular check-up, treating of contact and notify them for obvious infestations.
Head lice is also known as Pediculosis capitis. Lice are tiny, parasitic insects and their infection in the scalp affects many people globally every year. In fact, it takes place in every socioeconomic class and all countries. Lice are parasitic and obligate insects and have no-free living phase in their life cycle. They are transferred by fomite-skin contact or by direct skin-to-skin contact and symptoms usually develop three to four weeks after the initial infestation. Three species of lice that spread in human beings are Pthirus pubis (crab or pubic louse), Pediculus humanus (body louse), or Pediculus humanus capitis (head louse). Head louse is most prevalent and infests people of all classes, while body lice infest more often among displaced and homeless people. Infestation by body lice must be suspected in such people, as in the presence of cold weather, bad hygiene and scratching.
Very few publications exist on pediculosis. Head louse affects six to twelve million people annually in the United States, the exact number is unknown because it is not a reportable condition. Infestation with head lice is more prevalent in children between 3 to 12 years, with a greater predominance in girls than in boys. In industrialized countries, small epidemics usually develop in school children with tight social bonds and several members of the same household may be affected. During warmer months, particularly in areas with increased humidity, the infestation with head lice occurs more frequently. Body lice are usual during the cold season and in individuals of high sexual activity. Further epidemiological studies on pediculosis are required to know it better for developing control measures.
Patients often get pruritis, which is primarily caused by a hypersensitivity reaction that is of the immune-mediated type. The period between the first exposure, which needs to be two and six weeks to show the symptoms is longer than maybe one to two days after repeated exposure pruritis can occur. The feeling of being itchy promotes scratching, which in turn leads to the development of secondary bacterial infections such as pyoderma and impetigo that might later progress to being very severe. Body lice has the ability to transmit epidemic typhus, trench fever, and relapsing fever in humans.
Body lice and head lice are from 1 millimeter to 3 millimeters in length, while the pubic louse is so much smaller. The head louse is an obligatory parasite that spends its life on the human host. Head lice feed only on blood. Lice have no ability to jump or fly; they need close contact for transmission. The infestation of lice is considered to be transmitted by head-to-head contact, sharing headgear, or other direct contact with fomite. Pubic lice are spread by clothing and bedding or sexual contact. Body lice reside on and lay their eggs in bedding or clothing, only moving to the skin to feed. They mainly spread in people through direct contact where hygiene is not practiced well. However, they can be transferred by bedding, towels, and clothing also.
The prognosis for head lice is usually favorable. Medications are highly effective in destroying mature lice and nymphs if used correctly. Failures to treatment can occur due to several factors, including non-compliance with retreatment schedules, failure to eliminate live nits, lack of ovicidal activity, inappropriate usage of the pediculicide, insufficient environmental elimination, failing to treat close contacts, and drug resistance. While rare, some patients with body lice may come in contact with typhus, recurrent or relapsing fever or trench fever.
Children with head lice may be asymptomatic initially. However, itching limited to the scalp often develops as the first and most prominent symptom, and may become very severe. The louse cements its white-to-tan/gray, oval-shaped eggs, or nits, to hair shafts a few millimeters from the scalp, commonly behind the posterior and occipital auricular regions. Nits are more readily identified than adult crawling lice. Other possible symptoms of infestation by head lice include pyoderma without or with associated alopecia, fever, conjunctivitis, malaise, secondary impetiginization, occasional hypersensitivity eruption as diffuse morbilliform, and excoriation.
The diagnosis of head lice is typically made by identifying live lice, either through combing wet hair or inspection of scalp. Visual inspection alone can be challenging, as lice move quickly avoiding light. While finding nits attached to hair shafts does not confirm active infestation, the presence of nits within 1cm of the scalp makes active infestation more likely. The diagnosis can sometimes be confirmed using a hand lens or microscope.
Impetigo
Pyoderma
Epidemic typhus
Trench fever
Relapsing fever
Social embarrassment
Seborrhea
Eczema
Scabies
Dandruff
Superficial fungal infection
Folliculitis
Successful treatment of Pediculosis capitis combines an integrated approach to diagnosis, medicamentation, mechanical removal, environmental decontamination control, education, prevention, monitoring of treatment response, and management of treatment failure. Treatment adherence, re-treatment when appropriate accompanied by follow-up is an essential step.
Dermatology, General
Treatment of head lice also includes environmental modification. This would involve cleaning personal items; vacuuming furniture and floors; sealing non-washable items; using hair care tools; keeping away from hazardous insecticides; education of the contacts about the infestation; and regular examination of family members. Launder bedding, clothing, and the stuffed animals in hot water and dry on high heat for 20 minutes. Vacuum furniture and floors, especially around seams and crevices.
Dermatology, General
Pyrethin: It is a natural medicament extracted from chrysanthemum. It causes paralysis and neurotoxicity in head louse via interfering with Na+ transport. The half-life of the drug can be extended by adding piperonyl butoxide to pyrethins.
Dermatology, General
Permethrin (1%): This is a synthetic pyrethroid and frequently indicated treatment which is applied topically. It is an OTC medication that acts by altering the transport of sodium across the neuronal membranes and causes respiratory paralysis in the lice.
Malathion: Â It is an inhibitor of cholinesterase belonging to the class of organophosphates. It eradicates head lice by causing paralysis in them. It is used as 0.5% solution.
Lindane 1%: This belongs to organochlorides and causes lysis of lice by causing respiratory paralysis.
Spinosad 0.9%: This is a pediculicidal agent which is used topically. It acts by inducing hyperexcitation leading to the death of the lice by paralysis.
Topical ivermectin (0.5%): This lotion raises the levels of chloride in the muscles leading to paralysis and hyperpolarization. This must be employed as a third-line treatment.
Dermatology, General
The phases of management of head lice includes diagnosis, treatment, mechanical removal, education, prevention, etc.
Diagnosis:
This phase includes visual inspection and wet combing to detect lice.
Treatment:
Both over the counter and prescription treatments are available, with the latter being stronger.
Environmental control:
Decontaminate personal materials and seal un-washable items and, for therapy from the surroundings, vacuum areas.
Education:
Very important to educate or not sharing personal items, doing regular check-up, treating of contact and notify them for obvious infestations.
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