Lice and Scabies: Treatment Update

Pediculosis  and  scabies  are  caused  by  ectoparasites.  Pruritus  is  the  most  common  presenting  symp-tom.  Head  and  pubic  lice  infestations  are  diagnosed  with  visualization  of  live  lice.  Nits  (lice  eggs  or  egg  casings)  alone  are  not  sufficient  to  diagnose  a  current  infestation.  A  “no-nit”  policy  for  return  to  school  is  not  recommended  because  nits  can  remain  even  after  successful  treatment.  First-line  pharmacologic  treatment  for  pediculosis  is  permethrin  1%  lotion  or  shampoo.  Newer  treatments  are  available but costly, and resistance patterns are generally unknown. Noninsecticidal agents, including dimethicone  and  isopropyl  myristate,  show  promise  in  the  treatment  of  pediculosis.  Extensive  envi-ronmental decontamination is not necessary after pediculosis is diagnosed. In adults, the presence of pubic lice should prompt an evaluation for sexually transmitted infections. Body lice infestation should be suspected in patients with pruritus who live in crowded conditions or have poor hygiene. Scabies in adults presents as a pruritic, papular rash in a typical distribution pattern. In infants, the rash can also be vesicular, pustular, or nodular. First-line treatment for scabies is permethrin 5% cream. Clothing and bedding  of  persons  with  scabies  should  be  washed  in  hot  water  and  dried  in  a  hot  dryer.  Counseling  regarding appropriate diagnosis and correct use of effective therapies is key to reducing the burden of lice and scabies.

A related handout written for patients is attached 95220 patient handout.pdf

article (Letters to the Editor see http://phthiraptera.info/node/95321)

A previous version by the same authors published in 2012 title: Pediculosis and Scabies: A Treatment Update can be found in http://phthiraptera.info/node/95221

Response to the article (Letters to the Editor see http://phthiraptera.info/node/95321)