Lice (pediculosis)

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    Pediculosis is a benign contagious parasitic infection due to 3 species of lice specific to humans: head lice, body lice and pubic lice. Transmission from person to person occurs through direct or indirect contact.
    Body lice are potential vectors of relapsing fever (Chapter 7), typhus (Eruptive rickettsioses, Chapter 7) and trench fever.

    Clinical features

    • Head lice mainly affect children: itching and scratch marks (nape of neck and around the ears), which may become secondarily infected (impetigo) in prolonged infestation; presence of live lice and/or live (shiny, grey) nits attached to the hair shaft within 5 mm of the scalp.
    • Body lice mainly affect populations living under poor conditions (refugees, prisoners, the homeless): itching and scratch marks (back, belt line and armpits), often inflamed and infected; presence of lice and nits in the clothing (parasites are not found on the body).
    • Pubic lice are considered to be a sexually transmitted infection (STI): itching and scratch marks (pubic and perianal area), but other hairy areas may also be affected (armpits, thighs, eyelashes); lice and nits at the base of the hair shaft, rarely visible.
    • Examine contacts; check for associated systemic infection (body lice) or STI (pubic lice).


    Head lice

    • Apply lotion to scalp and dry hair, paying particular attention to the areas behind the ears and around the nape of the neck. Do not reduce or exceed the recommended duration of application.
      4% dimeticone lotion
      Children 6 months and over and adults: leave on hair for 8 hours, then rinse thoroughly. 
      Keep away from flames and/or intense heat sources (including cigarettes) during application and until rinsing (risk of ignition).
      or, if dimeticone is not available or in children 2 to 6 months:
      1% permethrin lotion. 
      Children 2 months and over and adults: leave on hair for 10 minutes, then rinse thoroughly.
    • Repeat application of either treatment after 7 days.
    • Decontaminate combs, headwear and bedding (wash ≥ 60 °C/30 minutes, iron or dry in the sun or, if not feasible, seal in a plastic bag for 2 weeks).
    • Treat as above contacts with live lice and/or live nits. Do not treat those with dead nits alone (dull, white, > 1 cm from scalp).

    Body lice

    Mass treatment (outbreak)

    Apply 30 to 60 g (2 to 4 heaped soup spoons) of 0.5% permethrin powder to the inside of the clothes and underclothes in contact with the skin (front and back, neck and waistline, sleeves and socks) in a fully clothed patient, then rub in the powder by hand. Leave for 12 to 24 hours.

    Treat other clothing (including headwear) and bedding in a plastic bag with 0.5% permethrin powder. Repeat in 8 to 10 days if the infestation persists.

    Individual treatment

    Disinfection of clothing and bedding as above or as for head lice.

    Pubic lice

    Shave and/or apply 1% permethrin lotion to hairy areas (as for head lice). Treat the partner at the same time. Decontaminate clothing and bedding (as for head lice). Repeat the application after 7 days.

    Treatment of secondary bacterial infection, if present, should begin 24 to 48 hours before local antiparasitic treatment (see Impetigo); local treatment is applied later when tolerated.