NEW YORK — Head lice and scabies are two common infestations that
can affect children, regardless of socioeconomic status and ethnicity, and have
nothing to do with hygiene, according to a presentation at the 23rd Annual
Infectious Diseases in Children Symposium held here.
Lice are most common among preschool and elementary school-aged
children, although caregivers and household members of those infested are at
increased risk. The main symptom of lice is itching that results from
sensitization to components from lice saliva, said Joseph A. Bocchini Jr.,
MD, professor and chairman of the department of pediatrics at the Louisiana
State University Health Sciences Center in Shreveport. The itching occurs 4 to
6 weeks after initial infestation.
“It should be clear that a diagnosis is made by a
pediatrician,” Bocchini said. “Parents can misdiagnose the children
based on dandruff, hair casts, hair debris, dried shampoo/conditioner and
hairspray, and can subject children to unnecessary treatment.”
The primary therapy is over-the-counter insecticides, most commonly
pyrethroids, although there has been significant emergence of resistance.
Insecticides should be given in two applications: the initial application and
one in 7 to 10 days to kill any eggs that have hatched since treatment. For
primary therapy failure, malathion lotion, benzyl alcohol or oral ivermectin
(Stromectol, Merck) are recommended.
“No healthy child should miss school because of
head lice,” said Bocchini, who is a member of the
Infectious Diseases in Children Editorial Board. “‘No
nit’ policies for return to school should be abandoned, and children
should return to school after treatment initiation.”
Scabies is a highly contagious skin infestation also seen in school-age
children. It is a pruritic, erythematous, papular eruption that is caused when
a female mite burrows into the upper layers of the skin. The itching is most
intense at night, and a rash develops at about 4 weeks after infestation. It
can affect infants, children and adults, and mimic eczema in infants and
children aged younger than 2 years.
scabies is 5% permethrin cream; in older children, it
should cover their entire body below the head, and in children aged younger
than 2 years, it should also be applied to the face, scalp and neck.
Alternatives include oral ivermectin or 10% crotamiton cream. Antihistamines
and topical corticosteroids may be used for itching.
Prophylactic therapy is recommended for household members, and children
can return to childcare or school after treatment is completed. Bedding and
clothing worn next to the skin before therapy initiation should be laundered in
hot water and dried on a hot cycle.
For more information:
- Bocchini JA. Itchy infestations: head lice and scabies. Presented at:
the 23rd Annual Infectious Diseases in Children Symposium; Nov. 20-21,
2010; New York City.