Phthirus pubis Infestation of the Scalp: A Case Report and Review of The Literature

Veraldi, Stefano; Pontini, Paolo; Nazzaro, Gianluca

doi:10.3347/kjp.2018.56.5.487

Cited by 19 publications

(12 citation statements)

References 12 publications

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“…This is rare but easily overlooked, tending to favour Asian or white patients with straight hair. There may be more numerous nits and lice compared with a head lice infestation, with more severe pruritus and consequent excoriations 30 …”

Section: Migrating P Pubis: Eyelashes and Scalpmentioning

confidence: 99%

A clinical review and history of pubic lice

Patel

Tan

Levell

2021

Clinical and Experimental Dermatology

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Summary The ectoparasite Pthirus pubis (PtP), commonly known as the crab or pubic louse, has plagued primates from prehistoric apes to Homo sapiens. We combed the literature from antiquity to the present day, reviewing the pubic louse’s origins, its evolution with mankind, and its presentation and management. MEDLINE and EMBASE provided the greatest yield of literature compared with other databases. Estimates for PtP incidence range from 0.3% to 4.6% and for prevalence around 2% in adults. War, disasters and overcrowding support lice transmission, but modern pubic hair grooming has reduced the incidence of PtP in recent years. PtP, is usually found on pubic hair, but may infest scalp and body hair, eyebrows and eyelashes. Reports suggest the possibility of PtP as a vector for Bartonella spp. and Acinetobacter spp., which require further study. Transmission of PtP is via close contact, so sexual abuse and concomitant sexually transmitted infections should be considered. Symptoms and signs of infestation include pruritus, red papules and rust/brown deposits from feeding or faecal matter. Visualization of live lice confirms the diagnosis. Traditional treatments include hand‐picking and combing, but in modern times pediculicidal products may generate faster resolution. Permethrin or pyrethrins are the first‐line recommendations. Resistance to pediculicides is common with head lice and is presumed likely with PtP, although data are lacking. Pseudoresistance occurs as a result of poor compliance, incorrect or ineffective dosing, and reinfestation. In true resistance, a different pediculicide class should be used, e.g. second‐line agents such as phenothrin, malathion or ivermectin. Lice have existed long before humans and given their adaptability, despite habitat challenges from fashion trends in body hair removal, are likely to continue to survive.

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Section: Migrating P Pubis: Eyelashes and Scalpmentioning

confidence: 99%

A clinical review and history of pubic lice

Patel

Tan

Levell

2021

Clinical and Experimental Dermatology

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“…Pthirus pubis is stocky and discoid in shape (i.e., crab-like shape) with 2–3 mm in length, while two other subspecies of lice (i.e., head louse and body louse) are very similar, with slender shape and 3–4 mm in length ( 1 , 2 , 19 ). At present, in addition to dermoscopy and light microscope ( 4 , 8 ), high-magnification slit-lamp microscopy is also helpful for the differential diagnosis ( 11 , 15 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: A case of corneal epithelial injury associated with Pthiriasis palpebrarum

Wang

Liu

2022

Front. Med.

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SignificancePhthiriasis palpebrarum is an uncommon infection due to Phthirus pubis inoculating the eyelashes and surrounding tissues of the eye. Because of its rarity, it may be misdiagnosed as blepharitis or conjunctivitis clinically.PurposeThis report described a rare case of corneal epithelial injury associated with Phthiriasis palpebrarum.Case reportA 59-year-old woman presented with 1 month history of repeated episodes of itching and irritation symptoms in both eyes. A slit-lamp examination was performed, which revealed mild conjunctival hyperemia and corneal epithelial defects in both eyes. On closer examination, crab-like lice, nits, and red pinpoint excretions were seen on her eyelashes and eyelids bilaterally. Corneal fluorescein staining in both eyes was observed, and tear film break-up time (BUT) in each eye was 2 s. Numerous lice were also found attached to the scalp hair. Therefore, a clinical diagnosis of corneal epithelial injury associated with Pthiriasis palpebrarum was made. For treatment, eyelashes with nits and/or lice were removed mechanically with a fine tweezers. Then, 0.01% Hypochlorous Acid eye wash was used to clean the eyelid margin twice daily. Also, she was prescribed a combination of Vitamin A Palmitate eye gel three times a day and Tobradex® eye ointment once daily. Meanwhile, the patient was provided with suggestions on how to improve personal hygiene and environmental hygiene, including cutting of the scalp hair and the application of 0.01% permethrin rinse. One week later, no evidence of lice and nits of the eyelashes and scalp hair was found, and the patient's symptoms and signs also improved significantly.ConclusionThis rare case suggested that the eyelashes of patients presenting with itching and irritation symptoms should be carefully examined with a slit-lamp. Besides removal of the parasites, attention should be paid to the treatment of corneal epithelial injury associated with Pthiriasis palpebrarum.

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“…However, it can also infest, in particular, hairy males or, when the infestation is longstanding, the thighs, abdomen, chest, axillae and beard. Involvement of the scalp is very rare (1).…”

Section: Diagnosis: Pthiriasis Of the Eyelashesmentioning

confidence: 99%