Lice

The two species that belong to this group include Pediculus humanus capitis (head louse) and P humanus corporis (body louse).84-88 The eggs (or nits) remain firmly attached to the hair, and in about 10 days the lice hatch to form nymphs, which mature in 2 weeks. The lice become attached to the base of the hair follicle and feed on the blood of the host.10 Pubic or crab lice is found on the hairs around the genitals but may occur in other parts of the body (e.g., eyelashes or axillae). Hypersensitivity to the secretions from lice can produce macular swellings and lead to secondary bacterial infections.

Treatment

© The agent of choice for all three infections (body, head, and crab lice) is 1% per-methrin (Nix). Permethrin has both pediculicidal and ovicidal activity against P. humanus capitis. The cure rate is reported to be between 90% and 97%. A cream rinse of permethrin 1% (Nix-Creme Rinse) is also available. Individuals with a history of hypersensitivity to ragweed or chrysanthemum may react to permethrin and should avoid this preparation. An alternative agent is oral ivermectin 100 mcg/kg for 3 days (days 1, 2, and 10). Permethrin can cause itching, burning, stinging, and tingling with application. Permethrin 1% should be applied to the dry scalp after shampooing and be left on the scalp for 10 minutes. The application may need to be repeated. Because of the reports of resistance to permethrin, an alternative agent is 0.5% malathion (Ovide), which has to be left on the scalp for 90 minutes and has also been found to be effective. For the relief of pruritus, calamine lotion with 0.1% menthol or an equivalent agent may be used. All individuals, including immediate family members and sexual partners of the primary host, should be treated. All bedding and clothes should be sterilized as previously indicated for enterobiasis.

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