Lesson 8 PEDICULOSIS (Skin Diseases Lesson for Nursing Students).pptx

All about Skin Diseases

1. Pediculosis Page 1

2. Pediculosis Pediculosis is  an  infestation of the hairy parts of the body or clothing with the eggs , larvae or adults of lice . The crawling stages of this insect feed on human blood , which can result in severe itching . Head lice are usually located on the scalp , crab lice in the pubic area and body lice along seams of clothing .

3. Epidemiology And Etiology Page 3 Etiology : Lice

4. Three types of lice: Head lice : Pediculus humanus capitis (2-3 mm long) Body lice : Pediculus humanus humanus (2.3-3.6 mm long) P ub i c l i ce ( crabs ): P h thirus pubis (1.1-1.8 mm long) Page 4

5. Head Lice Page 5 Body Lice Pubic Lice

6. Transmission Page 6 Direct contact between individuals. Indirect contact with bedding, brushes, or clothing, according to species. Pediculosis and scabies may coexist in the same individual

7. Secondary Infections of Excoriated Sites Page 7 Excoriation may become secondarily infected with S. aureus , GAS . Infection can extend, resulting in cellulitis , lymphangitis , and/or bacteremia

8. Clinical Manifestation Page 8 Pruritus occurs in a variable proportion. Excoriations can become secondarily infected.

9. Pediculosis may be divided into the following types : 1)Pediculosis capitis 2)Pediculosis corporis 3)Pediculosis pubis Pediculosis Page 9

10. An infestation of the scalp by the head louse. Feeds on scalp and neck and deposits its eggs on hair. Pediculosis Capitis Page 10

11. Epidemiology And Etiology Page 11 Etiology : The subspecies Pediculus humanus capitis

12. Epidemiology And Etiology Page 12 Sex, Age of Onset: Girls > boys. 3–11 years, but all ages. Race : In United States, more common in whites than blacks

13. Transmiss i on Page 13 Head-to-head contact. Shared hats, caps, brushes, combs; theater seats; pillows. Epidemics in schools; classrooms are the main source of infestations. Head lice can survive off the scalp for up to 55 h.

14. Predisposing Factors Page 14 School-age children and their mothers. More common in warmer months.

15. Sites of predilection Page 15 Head lice nearly always confined to scalp, especially occipital and postauricular regions . Rarely, head lice infest beard or other hairy sites. Although more common with crab lice , head lice can also infest the eyelashes ( pediculosis palpebrarum ).

16. Pediculosis capitis: multiple nits on scalp hair Page 16

17. Diagnosis Page 17 Clinical Diagnosis (Skin lesion ) Laboratory Examinations : Microscopy : The louse or a nit on a hair shaft Cultures : . If impetiginization is suspected, bacterial cultures should be obtained.

18. Management Page 18 1. Fomite/Environmental Control Avoid contact with possibly contaminated items such as hats, headsets, clothing, towels, combs, hair brushes, bedding, upholstery. The environment should be vacuumed . Bedding, clothing, and head gear should be washed and dried on the hot cycle of a dryer. Combs and brushes should be soaked in rubbing alcohol or Lysol 2% solution for 1 h . Families should check for lice routinely .

19. 2. Pediculocide Therapy Page 19 Topically Applied Insecticides : Ideally, should have 100% activity against louse and egg. Malathion kills all lice after 5 min of exposure, and >95% of eggs fail to hatch after 10 min of exposure. Permethrin are synthetic pyrethoids widely used as insecticide, a c aricide, and insect repellant.  Lotion preparations are preferred; creams , foams , gels are also available.

20. Page 20 Alternative Regimen : Lindane 1% shampoo : Applied for 4 min and then thoroughly washed off. (Not recommended for pregnant or lactating women.)

21. Page 21 Alternative Regimen : Ivermectin : 0.8% lotion or shampoo.

22. Page 22 Systemic Therapy: Oral ivermectin : 200 μg/kg; repeat on day 10 to kill emerging nymphs. oral ivermectin in cases of resistance to both pyrethroids and malathion

23. Pediculosis Corporis Page 23 In body louse infestations , lice reside and lay eggs in clothing . Leave clothing to feed on human host . Body louse survive more than a few hours away from the human host. Occurs in poor socioeconomic conditions .

24. Epidemiology And Etiology Page 24 Etiology : Pediculus humanus humanus.

25. Risk Factors : Poor socioeconomic conditions . when clothing is not changed or washed frequently : poverty , war , natural disasters , indigence , homelessness , refugee-camp populations . Page 25

26. Pediculosis corporis . Severely malnourished, ill-kept, homeless male with multiple excoriations, erosions and crusted papules, and nodules and eczematized lesions. Lice and nits are seen in the seams of clothing (inset). Page 26

27. Diagnosis : Page 27 Lice and eggs are found in clothing seams.

28. Management Page 28 Bedding and clothing must be systematically decontaminated . Hygiene Measures  Basic sanitation measures , and  hygiene measures to assure changes of clean clothing, body washing, and sometimes shaving.

29. Management Page 29 Delousing: Pyrethrins / pyrethroids or malathion for 8–24 h is recommended in some cases. Outbreaks necessitate delousing of individuals with 1% permethrin dusting powder . Louse-Borne Infections: Antibiotics are indicated if louse-borne infectious disease (trench fever, epidemic typhus) exists .

30. Pediculosis Pubis (Pthiriasis) Crabs Page 30 Sexually transmitted disease. Pediculosis pubis is an infestation of hair-bearing regions: Most commonly the pubic area Hairy parts of the chest and axillae Upper eyelashes . Manifested clinically by mild to moderate pruritus, papular urticaria, and excoriations.

31. Epidemiology And Etiology Page 31 Age : Most common in young adults; range, from childhood to senescence. Sex: More extensive infestation in males . Etiology : Pthirus pubis

32. Transmiss i on Page 32 Close physical contact : sharing bed; possibly exchange of towels. Sexual exposure . May coexist with another sexually transmitted infection (STI). Nonsexual transmission: homeless persons who have pubic lice in hair on head and back.

33. Often asymptomatic . Mild to moderate pruritus for months. Patient may detect a nodularity to hairs (nits or eggs) while scratching. With excoriation and secondary infection , lesions may become tender and be associated with enlarged lymph node in the inguinal region. Clinical Manifestation Page 33

34. Skin Lesions Page 34 Papular urticaria (small erythematous papules) at sites of feeding, especially periumbilical ; blisters. .

35. Secondary infection: detected in patients with significant pruritus . Maculae ceruleae ( taches bleues ): are slate-gray or bluish-gray macules 0.5–1 cm in diameter, irregular in shape, nonblanching. Pigment thought to be breakdown product of heme affected by louse saliva. Page 35

36. Eyelash infestation : Serous crusts may be present along with lice and nits , occasionally, edema of eyelids with severe infestation. Page 36

37. Laboratory Examinations Page 37 Microscopy Lice (Fig.) and nits may be identified and differentiated from head/body louse with hand lens or microscope. Cultures Bacterial cultures of impetiginized excoriation Serology Sexually transmitted. Testing for other STIs may be indicated in some individuals.

38. Management Page 38 Prevention : Patient and sexual partners should be treated. Use of Pediculocides

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