eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Pediculosis: Follow-up

Author: Lyn Guenther, MD, FRCP(C), Professor, Department of Medicine, Division of Dermatology, University of Western Ontario; Chief of Dermatology, London Health Sciences Center; Medical Director, The Guenther Dermatology Research Centre, Canada
Coauthor(s): Sheilagh Maguiness, BSc, MD, Department of Dermatology, University of Alberta; Thomas W Austin, MD, Professor Emeritus, Department of Medicine, Division of Infectious and Sexually Transmitted Diseases, University of Western Ontario, Canada
Contributor Information and Disclosures

Updated: May 5, 2009

Follow-up

Deterrence/Prevention

  • Environmental eradication
    • Fomites (eg, pillow cases, linens, towels, toys, hats) should be washed in hot water and dried. They should be exposed to temperatures greater than 50-55°C for at least 5 minutes. Any object that the infested child or parent has come into contact with should be washed thoroughly in hot water.
    • Another way to administer environmental control is to seal potential fomites in plastic bags for at least 2 weeks so that all the nits hatch and die without a blood meal.
    • Providing education to children about the sharing of hats, combs, and hair-ties is also a good idea.
    • Giving children separate areas to store their belongings in the classroom may help prevent the spread of lice.
  • Treatment of contacts
    • The treatment of family members, friends, and/or other close contacts is important in helping to prevent further spread of lice and in preventing reinfestation.
    • Patient education regarding treatment of contacts is essential.
    • Parents with children who are infested should be advised to treat the entire family with a pediculicide and to provide environmental fomite control.
  • Education about hygiene and accessibility to laundering facilities are important in preventing the spread of body lice and reinfestation.8

Prognosis

  • Causes of therapeutic failure
    • Misdiagnosis
    • Inappropriate treatment
    • Noncompliance
    • Insufficient application of pediculicide (ie, amount, duration)
    • Lack of ovicidal activity of pediculicide and failure to retreat in 7-10 days
    • Lack of removal of live nits
    • Lack of environmental eradication
    • Reinfestation
    • Resistance to pediculicide

Patient Education

  • Education is important with respect to the proper use of the chosen pediculicide, nit removal, and environmental control.
  • In cases of school-wide head louse infestations, all children and their family members should be examined for infestation. The preconceived notion that head lice are related to dirt and poor personal hygiene should be dispelled.
  • For excellent patient education resources, visit eMedicine's Parasites and Worms Center. Also, see eMedicine's patient education articles Lice and Crabs.

Miscellaneous

Medicolegal Pitfalls

  • In March 2003, the FDA issued a public health advisory warning of an increased adverse effects risk of lindane treatment in persons who are young, small, or elderly. Heightened caution should be exercised if lindane is used in these populations.
  • Human lice can be used as a forensic tool. A mixed DNA profile of 2 hosts can be detectable in bloodmeals of body lice that have had close contact between an assailant and a victim.15

Special Concerns

  • P corporis may be the vector for typhus, trench fever, and relapsing fever.
  • P pubis infestation may be associated with other sexually transmitted infections. In children, infestation is usually acquired from an infested parent and is rarely the consequence of sexual abuse; however, P pubis infestation maybe acquired secondary to sexual abuse, and the child should be examined for signs of abuse.
  • Resistance
    • Over the last few decades, the incidence of pediculosis has risen, as has the problem of increasing resistance of the lice to permethrin, which is the first-line treatment of choice in Europe and North America.
    • In England, head lice have been reported as resistant to permethrin and malathion, creating great difficulty in eradicating the pests.
    • Speculation exists that the insects have become resistant through several mechanisms, including mutating their target enzymes (eg, acetylcholinesterase) so that they no longer bind the organophosphate permethrin with the same affinity and increasing the metabolism of the insecticides, turning them into harmless compounds before they can damage the insects.
    • Emerging resistance will make the treatment of pediculosis more challenging in the future. As the insects avoid our battery of insults with treatments such as permethrin and malathion, alternating between these trusted pediculicides and the new oral antibiotics that have been shown to be effective will be necessary.
    • As more studies provide more information on the safety and efficacy of these compounds in the treatment of head lice, combination therapy may become the mode of treatment for this millennium. One thing is certain—these tough little critters will remain a problem; they have been causing infestations for 10,000 years and counting.
 


More on Pediculosis

Overview: Pediculosis
Differential Diagnoses & Workup: Pediculosis
Treatment & Medication: Pediculosis
Follow-up: Pediculosis
Multimedia: Pediculosis
References
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References

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Further Reading

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Keywords

pediculosis, lice, crabs, louse infestation, lice infestation, ectoparasites, pubic lice, pubic louse, head lice, head louse, body lice, body louse, Pediculus humanus capitis, P humanus capitis, Pediculus humanus corporis, P humanus corporis, Phthirus pubis, P pubis, Pediculus humanus humanus, P humanus humanus, human pests, Anoplura, sucking lice, insect infestation, insect bite, nit, vector-borne disease, typhus, relapsing fever, trench fever, plica polonica, vagabond disease, vagabond skin, pediculicide, permethrin, lindane, malathion, mercuric oxide ointment, pyrethrin, piperonyl butoxide, hexachlorocyclohexane

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Contributor Information and Disclosures

Author

Lyn Guenther, MD, FRCP(C), Professor, Department of Medicine, Division of Dermatology, University of Western Ontario; Chief of Dermatology, London Health Sciences Center; Medical Director, The Guenther Dermatology Research Centre, Canada
Lyn Guenther, MD, FRCP(C) is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, Canadian Dermatology Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, International Society for Dermatologic Surgery, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Society for Investigative Dermatology, and Society for Pediatric Dermatology
Disclosure: L'Oreale Consulting fee Consulting

Coauthor(s)

Sheilagh Maguiness, BSc, MD, Department of Dermatology, University of Alberta
Disclosure: Nothing to disclose.

Thomas W Austin, MD, Professor Emeritus, Department of Medicine, Division of Infectious and Sexually Transmitted Diseases, University of Western Ontario, Canada
Thomas W Austin, MD is a member of the following medical societies: American Venereal Disease Association, Canadian Infectious Disease Society, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey M Zaks, MD, Clinical Associate Professor of Medicine, Wayne State University School of Medicine; Vice President, Medical Affairs, Chief Medical Officer, Department of Internal Medicine, Providence Hospital
Jeffrey M Zaks, MD is a member of the following medical societies: American College of Cardiology, American College of Healthcare Executives, American College of Physician Executives, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

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