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4. Skin diseases
Lice (pediculosis)
P ed iculosis is a ben ign con tagious p arasitic in fection d ue to 3 sp ecies of lice sp ecific to
hum an s: head lice, bod y lice an d p ubic lice. T ran sm ission from p erson to p erson
occurs
through d irect or in d irect con tact.
B od y lice are p oten tial vectors of relap sin g fever (p age 1 8 2 ) , typ hus ( p age 1 8 5 ) an d
tren ch fever.
Clinical features 4
– H ead lice m ain ly affect child ren : itchin g an d scratch m ark s (n ap e of n eck an d
aroun d
th e ears) , w h ich m ay becom e secon d arily in fected ( im p etig o) in p rolon ged
in festation ; p resen ce of live lice an d / or live (shin y, grey) n its attached to th e h air
shaft w ithin 5 m m of the scalp .
– B od y lice m ain ly affect p op ulation s livin g un d er p oor con d ition s (refugees, p rison ers,
the hom eless): itchin g an d scratch m ark s (back , belt lin e an d arm p its), often in flam ed
an d in fected ; p resen ce of lice an d n its in the clothin g (p arasites are n ot foun d on the
bod y).
– P ubic lice are con sid ered to be a sexually tran sm itted in fection ( S T I ) : itch in g an d
scratch m ark s (p ubic an d p erian al area), but other hairy areas m ay also be affected
(arm p its, thighs, eyelashes); lice an d n its at the base of the hair shaft, rarely visible.
– E xam in e con tacts; check for associated system ic in fection ( bod y lice) or S T I ( p ubic
lice).
Treatment
Head lice
A p p ly to d ry hair 1% permethrin lotion (leave on for 1 0 m in ) or 0.5% malathion lotion
(leave on for 1 2 hours; 8 hours in child ren 6 m on ths-2 years). D o n ot red uce or exceed
th e recom m en d ed d uration of treatm en t. R in se th orough ly. D econ tam in ate com bs,
head w ear an d bed d in g (w ash ≥ 6 0 °C / 3 0 m in , iron or d ry in the sun or, if n ot feasible,
seal in a p lastic bag for 2 w eek s). T reat those con tacts w ith lice an d / or live n its, n ot
those w ith d ead n its alon e (d ull, w hite, > 1 cm from scalp ) as above. I t is recom m en d ed
to rep eat the ap p lication after 1 0 d ays.
Body lice
0.5% permethrin p ow d er to the in sid e of the clothes an d un d erclothes in con tact w ith the
F or mass treatment ( outbreak ) : ap p ly 3 0 to 6 0 g ( 2 to 4 h eap ed soup sp oon s) of
sk in (fron t an d back , n eck an d w aistlin e, sleeves an d sock s) in a fully clothed p atien t,
th en rub in th e p ow d er by h an d . L eave for 1 2 to 2 4 h ours. T reat oth er cloth in g
(in clud in g head w ear) an d bed d in g in a p lastic bag w ith 0.5% permethrin p ow d er.
R ep eat
in 8 to 1 0 d ays if the in festation p ersists.
Lice (pediculosis)
P ed iculosis is a ben ign con tagious p arasitic in fection d ue to 3 sp ecies of lice sp ecific to
hum an s: head lice, bod y lice an d p ubic lice. T ran sm ission from p erson to p erson
occurs
through d irect or in d irect con tact.
B od y lice are p oten tial vectors of relap sin g fever (p age 1 8 2 ) , typ hus ( p age 1 8 5 ) an d
tren ch fever.
Clinical features 4
– H ead lice m ain ly affect child ren : itchin g an d scratch m ark s (n ap e of n eck an d
aroun d
th e ears) , w h ich m ay becom e secon d arily in fected ( im p etig o) in p rolon ged
in festation ; p resen ce of live lice an d / or live (shin y, grey) n its attached to th e h air
shaft w ithin 5 m m of the scalp .
– B od y lice m ain ly affect p op ulation s livin g un d er p oor con d ition s (refugees, p rison ers,
the hom eless): itchin g an d scratch m ark s (back , belt lin e an d arm p its), often in flam ed
an d in fected ; p resen ce of lice an d n its in the clothin g (p arasites are n ot foun d on the
bod y).
– P ubic lice are con sid ered to be a sexually tran sm itted in fection ( S T I ) : itch in g an d
scratch m ark s (p ubic an d p erian al area), but other hairy areas m ay also be affected
(arm p its, thighs, eyelashes); lice an d n its at the base of the hair shaft, rarely visible.
– E xam in e con tacts; check for associated system ic in fection ( bod y lice) or S T I ( p ubic
lice).
Treatment
Head lice
A p p ly to d ry hair 1% permethrin lotion (leave on for 1 0 m in ) or 0.5% malathion lotion
(leave on for 1 2 hours; 8 hours in child ren 6 m on ths-2 years). D o n ot red uce or exceed
th e recom m en d ed d uration of treatm en t. R in se th orough ly. D econ tam in ate com bs,
head w ear an d bed d in g (w ash ≥ 6 0 °C / 3 0 m in , iron or d ry in the sun or, if n ot feasible,
seal in a p lastic bag for 2 w eek s). T reat those con tacts w ith lice an d / or live n its, n ot
those w ith d ead n its alon e (d ull, w hite, > 1 cm from scalp ) as above. I t is recom m en d ed
to rep eat the ap p lication after 1 0 d ays.
Body lice
0.5% permethrin p ow d er to the in sid e of the clothes an d un d erclothes in con tact w ith the
F or mass treatment ( outbreak ) : ap p ly 3 0 to 6 0 g ( 2 to 4 h eap ed soup sp oon s) of
sk in (fron t an d back , n eck an d w aistlin e, sleeves an d sock s) in a fully clothed p atien t,
th en rub in th e p ow d er by h an d . L eave for 1 2 to 2 4 h ours. T reat oth er cloth in g
(in clud in g head w ear) an d bed d in g in a p lastic bag w ith 0.5% permethrin p ow d er.
R ep eat
in 8 to 1 0 d ays if the in festation p ersists.
