Lice (pediculosis)

LICE

DESCRIPTION

An infestation of the body with parasitic lice.
Clinical features include:

  • itching
  • bite marks
  • presence of secondary eczema and secondary infection

CAUTION
Do not use commercial insect sprays as they are toxic.
Lotions used for the treatment of lice are toxic when swallowed.

Treat secondary infection with antibiotics. See Impetigo

HEAD LICE

B85.0

DESCRIPTION

Head lice are common in children. The eggs (nits) appear as fixed white specks on the hair.

GENERAL MEASURES

  • Use a fine comb to comb out the nits after washing hair.
  • Shaving of the head may expedite treatment, where socially acceptable.
  • Prevent spread by treating other contacts.
  • Remove nits from eyelashes by applications of white soft paraffin.

MEDICINE TREATMENT

  • Permethrin 5%, topical.
    • Apply permethrin 5% lotion to towel-dried or dry hair. Comb into hair repeatedly with a normal comb until scalp is covered completely.
    • Remove lice and nymphs with fine lice comb, by dividing scalp into sections and combing away from scalp.
    • Rinse lice comb in a white bowl filled with hot water between hair strokes to identify removed lice, or detach on white tissue paper. Paralysed and dead lice will present as dark spots (like ground pepper).
    • Take note of the physical size of removed lice and nymphs, as the size should get smaller with consecutive treatments.
    • Keep on combing with fine lice comb, rinsing or wiping comb frequently.
    • Permethrin 5% lotion is safe and can be left in the hair for up to one hour.
    • After combing, rinse hair with lukewarm water and wash permethrin 5% lotion out with normal shampoo (more than one foaming might be needed).
    • Repeat this procedure every 5 days for 3 weeks.
    • Thereafter, carry out frequent inspections to detect new infestations early.

Note:

  • Do not apply to broken skin or sores.
  • Avoid contact with eyes.

LoEIII [11]

BODY LICE

B85.1/B85.4

Body lice live in the seams of clothing and only come to the skin to feed.

Note: Body lice may carry typhus fever.

GENERAL MEASURES

Regularly wash bed linen and underclothes in hot water and expose to sunlight.

MEDICINE TREATMENT

Adults and adolescent children:

  • Benzyl benzoate 25% lotion, undiluted, applied over the whole body.
    • Leave on overnight and wash off the next day.
    • Repeat once a week for up to 3 weeks.

Note:

  • Do not apply to neck and face.
  • Avoid contact with eyes and broken skin or sores.
  • The lotion is toxic if swallowed.
  • Do not continue if a rash or swelling develops.
  • Itching may continue for 2–3 weeks after treatment.

LoEII [12]

PUBIC LICE

B85.3/B85.4

Pubic lice are acquired as STIs and nits are found on pubic hair and eyelashes.

GENERAL MEASURES

Prevent spread by treating other contacts.

MEDICINE TREATMENT

Benzyl benzoate 25%

Pediculosis of the eyelashes or eyebrows

Yellow petroleum jelly (Note: Do not use white petroleum jelly near the eyes).

LoEIII

REFERRAL

Lice infestation of eyelashes in children to exclude suspected sexual abuse.