| How is tx of bed bugs? | • Bites will typically resolve within 1-2 weeks
• For symptomatic relief, treat with potent
topical steroids and antihistamines
• Ultimate treatment requires detection and
eradication of the household infestation
• Bed linens need to be laundered and furniture
vacuumed |
| NA | NA |
| What is pediculosis (lice)? | • Three different varieties of lice may infest humans
Head lice – Pediculus humanus var. capitis
• Body lise – Pediculus humanus var. corporis
• Pubic or crab louse – Phthirus pubis
• Head lice are spread by close physical contact (brushes,
helmets, bedding)
• Commonly affects school-age children
• Affects all ethnic and socioeconomic groups, but is less
common in African-Americans |
| What are clinical features of pediculosis? | • Frequently associated scalp pruritus
• May also have posterior cervical lymph nodes
• Dermatitis may be present on the posterior
neck
• Nits are noted more commonly than lice on
exam (live lice scurry away from light)
• The most common sites to find nits are on the
retroauricular and occipital scalp
• Nits within 1 cm of the scalp are typically
viable. The distance may be greater in warm
environments
• Nits must be distinguished from hair casts.
Hair casts encircle the hair shaft and move
freely in contrast to the nit which is cemented
to the hair |
| How is pathogenesis of pediculosis? | • Female adult lice live 30 days and lay 5-10 eggs (nits) per day at the base of the hair where it meets the scalp
• Eggs hatch in 8-12 days
• Live eggs remain close to the scalp to maintain warmth and moisture but as the hair grows, the nits move off the scalp with the hair
• Because hair grows at a rate of ~ 1 cm per month, the duration of infestation can be estimated by the distance of the nit from the scalp
• The adult head lice is 2-3 mm in length and has six legs
• The presence of live adult lice, immature nymphs, and/or viable eggs indicate active infestation
• Lice typically survive 1-2 days away from the scalp. Eggs may survive up to 10 days away from the scalp |
| How is tx of lice? | • Individual patient factors should be assessed prior to
choosing a topical therapy (age, allergy history, prior
treatment, etc.)
• It is prudent to re-treat with topical therapies 7-9 days after initial therapy to kill the newly hatched lice
• First-line over-the-counter and prescription topical
therapies are listed on the following slide. Use OTC
permethrin 1% or pyrethrins when resistance is not
suspected
• Malathion 0.5% when resistance to permethrin or
pyrethrins is documented or when treatment with these
products fails
• Adjunctive nit combing can be performed
• Occlusive methods have also been used to
suffocate head lice using substances such as petroleum jelly, but study results have been variable |
| How is pt education regarding lice? | • All poeple living in the home should be examined
to avoid re-infestation
• Those with live lice or nits within 1 cm of the
scalp should be treated
• It is recommended to treat family members who
share a bed with the person with infestation,
even if no lice are found
• If it is not possible to examine household
members, treat without an exam if the treatment
is not contraindicated |
| How is management of clothes in lice? | • Clothing and bedding should be washed and
dried on the hot cycle of the dryer
• Brushes, combs and other hair care items can be
placed in hot (> 60°C) water for 10 minutes
• Non-washable items may be placed in the dryer
or stored in a sealed plastic bag for 3 days
• Children should not be restricted from attending
school because of lice |
| What are bed bugs? | • Cimex lectularius (most common type) affect
people from all racial and socioeconomic
groups
• May be spread during travel on clothing,
bedding, mattresses, and laundry, etc
• Stay hidden during the day and feed at night
• Bites may be multiple in a linear array;
referred to as “breakfast, lunch and dinner” |
| How is clinical presentation of bed bugs? | • Usually present as pruritic, erythematous and
edematous papules
• Onset and duration of lesions vary depending on
the patient's degree of sensitization
• Some individuals have little or no reaction to
bedbug bites
• Common for only one or a few family members
(even among those sleeping in the same bed) to
report lesions
• Red-brown in color with a segmented abdomen and vestigial wings |
| How is tx of bed bugs? | • Bites will typically resolve within 1-2 weeks
• For symptomatic relief, treat with potent
topical steroids and antihistamines
• Ultimate treatment requires detection and
eradication of the household infestation
• Bed linens need to be laundered and furniture
vacuumed |
