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Patients arrive with emotions ranging from annoyance to
sheer disgust at the discovery of an infestation with lice
or crabs and request acute medical care. There may be
extreme pruritis and the patient may bring in a sample of
the creature to show you. The adult forms of head lice
(pediculosis) can be very difficult to find but their oval,
light gray eggs (nits) can be readily found firmly attached
to the hairs above the ears and toward the occiput.
Secondary impetigo and furunculosis can occur. The adult
forms of pubic lice (pthirus or crab lice) are more easily
found, but their light yellow gray color still makes them
difficult to see. Small black dots present in infested areas
represent either ingested blood in adult lice or their
excreta.
A common alternate treatment for lice is lindane shampoo which is only available by prescription. One ounce is worked into the affected area for four minutes and then thoroughly rinsed out. Because of the very toxic nature of lindane, its use should be reserved for those cases that fail to respond to pyrethrins (RID). Treatment with either substance may not be ovicidal and therefore re-treatment after 7 to 10 days is often recommended.
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