Pediculosis
Background
- Caused by Pediculus humanus
- Hats/combs may act as fomites
Clinical Features
- May see live mites or nits (egg sacks) on hair shaft close to scalp
- May be asymptomatic or pruritic
Differential Diagnosis
Domestic U.S. Ectoparasites
See also travel-related skin conditions
Evaluation
- Generally a clinical diagnosis
Management
Over the Counter (OTC)
- Permethrin 1% lotion shampoo (if >2 months old)[1]
- Wash hair with non-conditioned shampoo
- Apply Permethrin for 10 min and rinse
- Repeat on day 9
- Pyrethrin lotion
- Apply to affected areas and wash off after 10 min
- Repeat in 7 days
- Dimethicone therapy
- First, apply the product to dry hair, then wait 10 min. Next, with product still in the hair, separate hair into small sections and comb hair to remove lice and eggs. Use a lice comb to remove lice and their eggs from hair. Finally, shampoo hair thoroughly with regular shampoo and warm water. Repeat as needed.[2]
Prescription
Reserved for failed OTC treatment
- Spinosad 0.9% topical suspension (if >6 months old)
- Apply to scalp and air and wash off after 10 min.
- Repeat in 10 days
- Malathion 0.5% lotion (if >6 years old)
- Applied to affected areas and wash after 8 hrs
- Repeat in 7 days
- Benzyl Alcohol 5% lotion (> 6 months old)
- Apply to dry hair and wash off after 10 min
- Repeat in 7 days
- Ivermectin 400mcg/kg PO
- Once on day 1 THEN once in 7 days
- Reserved for patients failing topical treatment
- Lindane therapy
- Only consider if patient has failed two prior prescription treatments
- Avoid in children <50 kg due to seizure association
Eyelash Infestation
- Apply ophthalmic petroleum jelly q12hrs x 10 days
Pediatrics <2yo
- Wet combing is an alternative to medical therapy
Disposition
- Discharge
- Children can return to school after first topical treatment has been applied
- Instruct parents and all close contacts to wash clothing and bedding in hot soapy water to avoid disease spread