Pediculosis and Scabies: A Treatment Update

Pediculosis  and  scabies  are  caused  by  ectoparasites.  Pruritus  is  the  most  common  presenting  symptom.  Head  and  pubic lice infestations are diagnosed by visualization of live lice. Finding nits (louse egg shells) alone indicates a his-torical  infestation.  A  “no  nit”  policy  for  schools  and  day  care  centers  no  longer  is  recommended  because  nits  can  persist after successful treatment with no risk of transmission. First-line pharmacologic treatment of pediculosis is permethrin 1% lotion or shampoo. Multiple novel treatments have shown limited evidence of effectiveness superior to permethrin. Wet combing is an effective nonpharmacologic treatment option. Finding pubic lice should prompt an evaluation for other sexually transmitted infections. Body lice infestation should be suspected when a patient with poor hygiene presents with pruritus. Washing affected clothing and bedding is essential if lice infestation is found, but no other environmental decontamination is necessary. Scabies in adults is recognized as a pruritic, papular rash with  excoriations  in  a  typical  distribution  pattern.  In  infants,  children,  and  immunocompromised  adults,  the  rash  also can be vesicular, pustular, or nodular. First-line treatment of scabies is topical permethrin 5% cream. Clothing and  bedding  of  persons  with  scabies  should  be  washed  in  hot  water  and  dried  in  a  hot  dryer.

An updated version by the same authors title- Lice and Scabies: Treatment Update can be found in http://phthiraptera.info/node/95220