Pediculosis/Lice

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Infestation by lice, usually in the hairy parts of the body. Usually found on the scalp, armpits, chest or pubic area.

Cause

  • Pediculosis humanus (capitis, corporis, pubis)
  • Usually transmitted directly by person-to-person contact but may also be transmitted indirectly via the clothing, towels, and bedding of infested persons

Clinical features

  • Severe itching of affected areas, scratch marks
  • Nits (white eggs) attached to hairs
  • Direct observation of lice
  • Continued scratching may lead to secondary bacterial infection and eczemas

Differential diagnosis

  • Seborrhoeic dermatitis

Investigations

  • Direct observation of lice/nits

ManagementTreatment

  • Shave the affected area
  • Apply pediculocide to kill lice
    • Apply benzyl benzoate lotion 25% and leave on overnight
    • Child 2-12 years: dilute the lotion with an equal part of water before application
    • Child <2 years: dilute 1 part of lotion with 3 parts of water, leave on for 12 hours. Apply ONLY once
    • Comb with a fine toothed comb if not shaved

Note:

Head lice

  • Do not use undiluted BBA in children <2 years. It is very irritant to the eyes
  • If the head is not shaved, ensure that the BBA is massaged well into the scalp
  • Soak all brushes and combs in BBA for at least 2 hours

Pubic lice

  • Treat all sexual partners at the same time

Prevention

  • Personal hygiene (washing clothes and regular bathing)
  • Avoid close contact with infected people
  • Treat the whole family
  • Avoid sharing combs, towels, etc