Lice (Pediculosis)
Parasitic Infestations of the Skin
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DESCRIPTION
An infestation of the body with parasitic lice.
Clinical features include:
- Itching
- Bite marks
- Presence of secondary eczema and secondary infection
| CAUTION Do not use commercial insect sprays as they are toxic. Lotions used for the treatment of lice are toxic when swallowed. |
Note:
Treat secondary infection with antibiotics. See: Impetigo
HEAD LICE
ICD 10 code: B85.0
DESCRIPTION
- Head lice are common in children. The eggs (nits) appear as fixed white specks on the hair
GENERAL MEASURES
- Use a fine tooth comb to comb out the nits after washing hair
- Shaving of the head may expedite treatment, where socially acceptable
- Prevent spread by treating other contacts
- Remove nits from eyelashes by applications of white soft paraffin
MEDICINE TREATMENT
- Permethrin 5%, topical
- Apply permethrin 5% lotion to towel-dried or dry hair. Comb into hair repeatedly with a normal comb until scalp is covered completely
- Remove lice and nymphs with fine lice comb, by dividing scalp into sections and combing away from scalp
- Rinse lice comb in a white bowl filled with hot water between hair strokes to identify removed lice, or detach on white tissue paper. Paralysed and dead lice will present as dark spots (like ground pepper)
- Take note of the physical size of removed lice and nymphs, as the size should get smaller with consecutive treatments
- Keep on combing with fine lice comb, rinsing or wiping comb frequently
- Permethrin 5% lotion is safe and can be left in the hair for up to one hour
- After combing, rinse hair with lukewarm water and wash permethrin 5% lotion out with normal shampoo (more than one foaming might be needed)
- Repeat this procedure every 5 days for 3 weeks
- Thereafter, carry out frequent inspections to detect new infestations early
- Do not apply to broken skin or sores
- Avoid contact with eyes
LoE: IIIb14
BODY LICE
ICD 10 code: B85.1/ B85.4
- Body lice live in the seams of clothing and only come to the skin to feed
Note:
Body lice may carry typhus fever
GENERAL MEASURES
- Regularly wash bed linen and underclothes in hot water and expose to sunlight
MEDICINE TREATMENT
Adolescents and adults:
- Benzyl benzoate 25% lotion, undiluted, once weekly for 3 weeks
- Apply over the whole body, excluding the neck and face
- Leave on overnight and wash off the next day
Note:
- Avoid contact with eyes and broken skin or sores.
− The lotion is toxic if swallowed.
− Do not continue if a rash or swelling develops.
− Itching may continue for 2–3 weeks after treatment
LoE:IIIb15
PUBIC LICE
ICD 10 code: B85.3/B85.4
DESCRIPTION
- Pubic lice are acquired as STIs and nits are found on pubic hair and eyelashes
GENERAL MEASURES
- Prevent spread by treating other contacts
MEDICINE TREATMENT
- Benzoyl benzoate 25% lotion, apply once weekly for two weeks
- Apply to affected area
- Leave on for 24 hours, then wash thoroughly
- Repeat in 7 days
For pediculosis of the eyelashes or eyebrows:
- Yellow petroleum jelly
Note:
Do not use white petroleum jelly near the eyes
- Apply to the eyelid margins (cover the eyelashes) daily for 10 days to smother lice and nits
- Do not apply to eyes
LoE: IVb
REFERRAL
- Lice infestation of eyelashes in children to exclude suspected sexual abuse
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 5: Skin Conditions_5.7.1 Lice (Pediculosis)