Head lice infestations in rural Honduras: the need for an integrated approach to control neglected tropical diseases.

BACKGROUND: Pediculosis capitis is a neglected tropical disease (NTD) that receives little attention in countries where it continues to be endemic. This study aimed to understand the impact of Pediculus humanus capitis infestations in the lives of Honduran children living in extreme poverty. METHODS: A qualitative study on head lice infestation was conducted in June 2016 in a rural community in Honduras. Parents were invited to bring their children for head lice inspection using a dry-combing technique with a stainless steel-toothed comb with suction power. A semistructured questionnaire was administered to participants. Questions were broadly grouped into knowledge about transmission, control practices, barriers to treatment, and the overall impact of these infestations in children's wellbeing. Responses were coded, categorized, and organized through a theme-based approach. RESULTS: In total, 52 children aged 2-14 years (42 girls) and their mothers were enrolled in the study. The overall proportion of children with an infestation was 83%. Response analysis revealed a lack of understanding regarding lice transmission and stigmatization of infested children and the widespread belief that head lice were acquired during bathing in the slow-flowing river running through the village. An agricultural plaguicide was commonly used to rid children of head lice. CONCLUSIONS: The study underscores the dire situation of the rural poor, their physical and mental health affected by pediculosis capitis as well as other NTDs. These results highlight the need to reassess approaches and action towards combating NTDS under an integrated framework.

Lichen planopilaris in a Latin American (Chilean) population: demographics, clinical profile and treatment experience.

BACKGROUND: Lichen planopilaris (LPP) is characterized by lymphocytic infiltrate, fibrosis and potential destruction of the hair follicle. Demographic and clinical studies in LPP are limited, and racial differences have not been thoroughly investigated. AIM: To analyse epidemiological data and clinical profiles of Chilean adults with LPP, and report on the treatments used. METHODS: This was a retrospective review of medical records and clinical follow-up of Chilean adults with a clinical and histopathological diagnosis of LPP. Treatment response was categorized clinically as none (with progression of condition), mild or satisfactory. RESULTS: The study assessed 103 patients with LPP [67 women (mean age 54.1 years) and 36 men (mean age 39.1 years)]. Of the 103 patients, 41 women and 34 men were diagnosed with classic LPP (CLPP) and 26 women and 1 man with frontal fibrosing alopecia (FFA), while Graham-Little-Piccardi-Lassueur syndrome (GLPLS) was identified in 1 man. Men with CLPP had a significantly (P < 0.001) earlier age of onset than women. Scalp dysaesthesia, erythema and peripilar hyperkeratosis were common findings, and 51 (66%) of patients with CLPP had cicatricial patches, most of which were circumscribed in the vertex area. All patients with FFA had band-like scarring in the frontal and temporal hairlines. Morbidities associated with LPP were hypothyroidism, dyslipidaemia, hypertension and depression. For most patients, treatment halted or improved their inflammatory/scarring condition. A sustained combination of at least one topical (clobetasol, minoxidil and salicylic acid) and one systemic (cetirizine, hydroxychloroquine, finasteride, methotrexate and isotretinoin) medication was necessary in all of our patients with LPP. CONCLUSION: This investigation is one of the first to describe the demographic, clinical and therapeutic features of LPP in a Latin American population. Similar profiles to previous reports may encourage research in larger multicentre international studies.

Acne keloidalis nuchae: risk factors and associated disorders - a retrospective study.

BACKGROUND: Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis which usually occurs in young adult males of African descent. Studies have suggested that AKN may be associated with other dermatologic conditions and even general medical disorders. The aim of this study was to identify cutaneous and extracutaneous associated disorders and to examine risk factors in our population for developing AKN. METHODS: The study was a retrospective, descriptive, and analytical study conducted at the Dermatology Outpatient department of the University Hospital of the West Indies. Data were obtained from the medical records of patients diagnosed over a 15-year period (2000-2014). RESULTS: There were 1031 new patients during the study period. Of these, 43 (4.2%) had AKN. The male to female ratio for AKN was approximately 7:1. Pseudofolliculitis barbae was associated with keloidal plaques on the scalp (OR = 6.22, P = 0.036). Also, when the duration of AKN was divided into two groups (0-5 years and greater than 5 years), there was an association between keloidal plaques and duration of greater than 5 years (OR = 7.5, P = 0.032). However, when the odds ratio was adjusted, only the duration of AKN remained significantly associated with keloidal plaques (OR = 7.08, P = 0.047). Chronic scalp folliculitis (P = 0.001) and the presence of any component disease of the metabolic syndrome (OR = 14, P = 0.008) and specifically hypertension (OR = 6.75, P = 0.036) were significantly associated with the extension of the lesions beyond the nape and occipital scalp. CONCLUSIONS: Pseudofolliculitis barbae, chronic scalp folliculitis, and aspects of the metabolic syndrome may be associated with acne keloidalis nuchae.

Pityriasis amiantacea: a study of seven cases.

Pityriasis amiantacea was first described in 1832. The disease may be secondary to any skin condition that primarily affects the scalp, including seborrheic dermatitis. Its pathogenesis remains uncertain. We aim to analyze the epidemiological and clinical profiles of patients with pityriasis amiantacea to better understand treatment responses. We identified seven cases of pityriasis amiantacea and a female predominance in a sample of 63 pediatric patients with seborrheic dermatitis followed for an average of 20.4 months. We reported a mean age of 5.9 years. Five patients were female, with a mean age of 9 years. All patients were successfully treated with topic ketoconazole.

[Epidemiological study of Pediculosis in elementary schools of Arica, northern Chile]. / Estudio epidemiológico de la Pediculosis en escuelas básicas del extremo norte de Chile.

UNLABELLED: Pediculosis is an ectoparasitosis infestation that has not received much attention in northern Chile despite it is a common reoccurring condition among school-age children. The objective of this study is to determine the prevalence of Pediculus humanus capitis infestation in elementary schools of Arica. PATIENTS AND METHOD: A group of 665 elementary school students from the Province of Arica were screened between August and November 2010; 467 children who met the inclusion criteria were selected. After parents and students signed an informed consent, the diagnosis was carried out through examination of the head with naked eye in each participating school, recording the presence of Pediculus humanus capitis, infestation level and parasite stage. RESULTS: 40.3% (188) of the children presented Pediculosis; the six schools studied were affected. Pediculosis infestation in girls reached 55.2% (138/250) and 23% (50/217) in boys. CONCLUSION: The school population of Arica is significantly affected by Pediculosis and its prevalence is similar to other regions.

[Prevalence of Malassezia species associated with seborrheic dermatitis lesions in patients in Argentina]. / Prevalencia de especies de Malassezia asociadas a lesiones de dermatitis seborreica en pacientes de Argentina.

BACKGROUND: Seborrheic dermatitis (SD) is considered the second most frequently dermatosis associated with the genus Malassezia but little is the knowledge about the epidemiology of this association. AIMS: To determinate the prevalence of Malassezia species associated with SD and to analyse their distribution according to the location of the lesion on the body. METHODS: This study was performed in Resistencia city, located in a subtropical area in northeast Argentina. In this study, 226 skin samples from patients with lesions compatible with SD were studied. Age, gender and body sites lesion were recorded. Strains were identified by PCR-RFLP. RESULTS: One hundred and thirty-one positive cultures were obtained. Association of 2 species was detected in 10 cases; therefore, 141 strains were isolated. Malasezzia globosa (43.3%) was the most frequent species isolated, followed by Malasezzia furfur (20.6%), Malasezzia sympodialis (17%) and Malasezzia restricta (16.3%). Three isolates of Malasezzia slooffiae (2.1%) and one of Malasezzia pachydermatis (0.7%) were obtained. Statistical significance (P<0.05) was found between M. globosa and scalp. Malasezzia restricta was isolated only in head areas. CONCLUSIONS: This study suggests M. globosa is the most related species to SD. The prevalence of other species is different from that reported by other authors. Only M. globosa and M. restricta presented a pattern of relationship with the body sites of the lesions. It is noteworthy is the isolation of the zoophylic species M. pachydermatis. The Malassezia genus ecology and the pathogenic role of its species are still under study. This work is a contribution to this knowledge.

Acute morbidity associated with scabies and other ectoparasitoses rapidly improves after treatment with ivermectin.

In resource-poor settings, scabies is associated with considerable morbidity. Which factors determine morbidity and how rapidly it recedes after specific treatment is not known. Patients with scabies were recruited in three urban slums in Fortaleza, Northeast Brazil. Diagnosis was established according to dermatoscopy, skin scraping, or adhesive film test. Severity of scabies-associated morbidity was assessed semiquantitatively. Patients and close contacts were treated with oral ivermectin (200 µg/kg, repeated after 7 days) and followed up for 2 weeks. Ninety-five patients were included in the study. Papules were the most common lesion type (98.9%). Excoriations due to scratching were observed in 43.2% and bacterial superinfection in 24.2%. Predilection sites were the arms (82.1%) and the abdomen (81.1%). At baseline, 36.3% of patients complained about intense or severe itching. Intense or severe itch decreased to 6.3% 2 weeks after treatment (p=0.02). Whereas 37.5% of the patients complained about intense or severe itch-related sleep disturbances at baseline, only 8.8% reported the symptom 2 weeks after treatment (p=0.35). At baseline, the degree of itching was correlated with the degree of sleep disturbance (ρ=0.64; p<0.001). One week after the first dose of ivermectin, the intensity of itching and of sleep disturbance decreased significantly (p<0.001). In patients living in resource-poor setting, scabies was associated with considerable morbidity. Treatment with ivermectin rapidly reconstituted health in almost all cases.

Scalp seborrheic dermatitis: prevalence and associated factors in male adolescents.

BACKGROUND: The prevalence of seborrheic dermatitis (SD) in the general population is variable in the literature. Factors associated with SD are not well understood. OBJECTIVE: To verify the prevalence of scalp SD in a selected survey of male adolescents on mandatory military service and to find possible associated factors (skin color, socioeconomic level, triceps skin fold, acne, and tobacco consumption). METHODS: This cross-sectional study included 18-year-old male adolescents on compulsory military service in a southern Brazilian city. Scalp SD was considered as erythema and scaling in any part of the scalp. Skin color, socioeconomic level, triceps skin fold, acne, and tabagism comprised the independent variables studied in our population. RESULTS: A total of 2201 adolescents entered the study. The global prevalence of scalp SD was 11%. White skin [adjusted prevalence ratio (PR) 1.42; 95% CI 1.06-1.92; P = 0.02] and triceps skin fold >19.5 mm (adjusted PR 1.56; 95% CI 1.12-2.18; P = 0.009) were significantly associated with scalp SD. The other variables were not associated with the outcome. CONCLUSIONS: Prevalence of scalp SD in our survey of male adolescents was 11%. The occurrence of scalp SD was associated with white skin and a higher body fat content.

Prevalence of pediculosis capitis in children from a rural school in Yucatan, Mexico.

We conducted an analytical cross-sectional survey to estimate the prevalence of and factors associated with active head lice infestation. In total 140 children, aged 6 to 16-years, from a public school in rural Yucatan, Mexico, were examined by wet-combing. A structured questionnaire was used to collect information on individuals and the conditions in the surrounding environment. Head lice infestation was found in 19 out of the 140 children tested (13.6%) and this was associated with both lower income (OR 9.9, 95% CI 2.15-45.79, p = 0.003) and a higher frequency of hair washing (OR 8, 95% CI 1.58-50, p = 0.012). Intersectoral control programs that take into account the socioeconomic differences of children should be implemented.

Prevalence of pediculosis capitis in children from a rural school in Yucatan, Mexico / Prevalência de pediculose em crianças de escola rural em Yucatan, Mexico

We conducted an analytical cross-sectional survey to estimate the prevalence of and factors associated with active head lice infestation. In total 140 children, aged 6 to 16-years, from a public school in rural Yucatan, Mexico, were examined by wet-combing. A structured questionnaire was used to collect information on individuals and the conditions in the surrounding environment. Head lice infestation was found in 19 out of the 140 children tested (13.6 percent) and this was associated with both lower income (OR 9.9, 95 percent CI 2.15-45.79, p = 0.003) and a higher frequency of hair washing (OR 8, 95 percent CI 1.58-50, p = 0.012). Intersectoral control programs that take into account the socioeconomic differences of children should be implemented.

Foi conduzido um estudo numa escola publica de área rural em Yucatan, Mexico com o objetivo de estimar a prevalência de pediculose e fatores de risco associados. Das 140 crianças incluídas 19 (13.6 por cento) apresentaram pediculose. A infestação de piolho foi associada com baixa renda (OR 9.9, 95 por cento CI 2.15-45.79, p = 0.003) e maior frequência de lavagem de cabelos (OR 8, 95 por cento CI 1.58-50, p = 0.012). Programas intersetoriais de controle da pediculose que levam em conta as características socioeconômicas das crianças deveriam ser executados.

Knowledge, attitudes and practices regarding head lice infestations in rural Nigeria.

INTRODUCTION: Head lice infestations are common in sub-Saharan Africa, but knowledge, attitudes and practices have never been studied in this region. METHODOLOGY: This population-based study was conducted in a small rural community (population = 590) in Kwara State, Central Nigeria. Inhabitants of the community were interviewed regarding head lice infestations, using a pre-tested structured questionnaire, and examined regarding the presence of active pediculosis. RESULTS: Of the 496 participants included, 367 (74.0%) had experienced head lice infestations, but only 26 (11.1%) of the individuals older than 15 years knew the correct mode of transmission. Of 142 individuals with active pediculosis, only 1 (0.7%) felt ashamed. Treatment was most commonly done by grooming (46.3%), followed by combing (27.2%). Only 4.6% used pediculicides, and 21.8% did not apply any treatment. Opinions about difficulties in controlling head lice were asked in three groups: biological, technical and social. In the first group, the most common difficulty noted was detecting head lice (52.1%), followed by possible resistance that would lengthen the time of infestation (38.9%). Technical constraints included concerns on the safety and effectiveness of products (48.7%) and difficulties in obtaining treatment (46.2%). Social contraints included difficulty in treating children (24.4%), lack of knowledge (23.5%), and the social behavior of children (22.2%). CONCLUSIONS: Head lice were not perceived as an important disease in a rural Nigerian community, and feelings about the infestation were mostly indifferent. Despite its common occurrence, knowledge on head lice was limited.  

Incidence of dermatophytosis in a public hospital of São Bernardo do Campo, São Paulo State, Brazil.

The incidence of cases of dermatophytosis in dermatology outpatient departments has increased in recent years. Infection control is essential to prevent transmission, and accurate diagnosis of this type of infection is important to avoid confusion with other dermatological processes caused by non-fungal agents. The objective of this study was to determine the incidence of dermatophytosis and its etiological agents in a public hospital of São Bernardo do Campo, Brazil. From February 2005 to May 2006, 273 samples were collected from 191 patients in a public dermatology outpatient department. The samples were collected according to conventional methods used in clinical mycology and direct examinations and cultures were performed. Of the samples suspected of fungal infection, 19% produced positive cultures, and the largest number of samples was from female patients between 31 and 40 years old. The most commonly infected area was the toenails, and the most common infective agents according to microscopic analysis and biochemical tests were the Candida species, which were responsible for 61.6% of the infections. These data agree with findings reported in the literature indicating a lower prevalence of filamentous fungi, such as Epidermophyton, Trichophyton, and Microsporum, in dermatomycosis.

An outbreak of scalp white piedra in a Brazilian children day care.

White piedra is a superficial mycosis caused by Trichosporon spp. that affects the hair shaft of any part of the body. It is presented an outbreak of scalp white piedra seen in 5.8% of the children frequenting a day care in Northeastern of São Paulo State, Brazil. Mycological exam and culture identified T. cutaneum in all five cases, and scanning electron microscopy of nodules around hair shaft infected by Trichosporon spp. is demonstrated comparing them with those of black piedra and with nits of Pediculous capitis.

An outbreak of scalp white piedra in a Brazilian children day care / Surto de piedra branca afetando os cabelos do couro cabeludo de crianças em creche brasileira

White piedra is a superficial mycosis caused by Trichosporon spp. that affects the hair shaft of any part of the body. It is presented an outbreak of scalp white piedra seen in 5.8 percent of the children frequenting a day care in Northeastern of São Paulo State, Brazil. Mycological exam and culture identified T. cutaneum in all five cases, and scanning electron microscopy of nodules around hair shaft infected by Trichosporon spp. is demonstrated comparing them with those of black piedra and with nits of Pediculous capitis.

Piedra branca caracteriza-se por ser micose superficial, causada por Trichosporon spp., que compromete a haste dos pelos de qualquer região do corpo. Um surto de piedra branca, afetando os cabelos do couro cabeludo, foi registrado em 5,8 por cento das crianças que freqüentavam uma creche na região nordeste do estado de São Paulo. Exame micológico direto e cultura identificaram T. cutaneum nas cinco crianças afetadas. Enfatiza-se a utilização da microscopia eletrônica de varredura, que mostrou nódulos circundando a haste dos cabelos infectada por Trichosporon spp., comparando-os com nódulos de Piedra nigra e com lêndeas de Pediculus capitis.

[Pediculosis prevalence and associated risk factors in a nursery school, Bogotá, Colombia]. / Prevalencia y factores asociados a la pediculosis niños de un jardín infantil de Bogotá

INTRODUCTION: Pediculosis is one of the most important chronic infestations in schoolchildren worldwide. Infestations show a high prevalence among the poorest children in developing countries, and it is associated with substandard hygienic practices. OBJECTIVE: The prevalence was estimated and seasonality described of a Pediculus infestation of seven months duration in a nursery school. Associations were explored among the standards of hygienic practices and hair characteristics. MATERIALS AND METHODS: One hundred and seventy-eight nursery school children between the ages of 3 months to 5 years, from the nursery school located at National University of Colombia, Bogotá, were participants in the study. The children were examined for presence of Pediculus humanus infestation each month for seven months. The lengths and thicknesses of hair were measured at the first examination. A survey requesting information on socioeconomic and hygienic practices was provided to the caretakers of the children. Prevalence rates with 95% confidence intervals were estimated for each explored association, and also to describe the differences of prevalences between age groups in each period. RESULTS: The highest prevalence was found in the children between the ages of 4 and 5 years, at the beginning of the school year. A positive association was indicated between Pediculus infestation and hair longer than 11.5 cm [prevalence rate (PR)=2.0; 95% confidence interval (CI): 0.82-4.8], washing the hair less than three times a week (PR=1.58; 95%CI: 0.58-4.7), as well as sharing cleaning implements (PR=1.31; 95%CI: 38-4.46) and living with more than five people at home (PR=2.04; 95%CI: 0.8-5.06). Due to the limited size of the sample, none of the associations found were statistically significant. CONCLUSION: Pediculus infestation has a high prevalence in children of the nursery school studied. This infestation is associated with substandard hygienic practices, living with more than five people at home and the length of hair.

[Presenting skin disorders in black Afro-Caribbean patients: a multicentre study conducted in the Paris region]. / Motifs de consultation en dermatologie des sujets de peau noire d'origine africaine et antillaise: enquête multicentrique en région parisienne.

BACKGROUND: There have been few studies in France concerning the specific features of dermatological practice regarding dark skin (Fitzpatrick's phototype V and VI) or the special requirements of black African and Afro-Caribbean patients. AIM: To determine the principal reasons for dermatological consultation among black patients of African or Afro-Caribbean descent in the Paris region. METHODS: This was a prospective clinical study conducted between 15 February and 15 May 2004. The diagnoses of cutaneous conditions leading to dermatological consultation for all black patients of phototype V to VI were recorded by 10 dermatologists practicing in 14 centres within the Paris region. LIMITS: The method used did not allow any conclusions to be drawn regarding the incidence of the presenting conditions among the global population nor did it allow comparison between populations of different phototypes. The absence of any preset list of diagnoses or of precise inclusion criteria regarding evaluation of skin colour left individual investigators with a broad margin of interpretation. RESULTS: In 836 adults and 228 children (half of whom were from Africa and half from the West Indies), diagnoses were as follows: acne in 29.2% of adults and 13.2% in children, and eczema in 6.8% of adults and 27.2% of children. Among dermatoses more specific to black subjects, scalp conditions were frequently seen in both adults (alopecia 7% of diagnoses) and children (tinea capitis 9.6% and alopecia 3.6% of diagnoses). In at least 25% of cases, consultation was associated with dyschromia. Clinical signs suggesting the use of skin lightening products were seen in 95 patients. CONCLUSION: In France, as in other industrialized countries, black patients consult dermatologists essentially for common benign dermatoses also seen amongst white people. Nevertheless, it is important to emphasise the presence of skin problems specific to black patients such as dyschromia and pigmentary disorders, hair and scalp dermatoses, and side effects associated with the use of skin lightening products.

Survey assessment of parental perceptions regarding head lice.

BACKGROUND: Head lice constitute a problem in children. Each year, numerous cases of pediculosis occur worldwide. Little work has been performed to evaluate the understanding, opinions, and actions of populations regarding head lice. These areas are important as they enable clinicians and educators to alert parents on how to avoid treatments that are innocuous or of high risk to patients. METHODS: A cross-sectional study was performed by interviewing the heads of households of 100 randomly chosen residences within the study area. RESULTS: The results obtained showed that 13% were infested during the first week of the survey, and 86% in the 24 weeks prior to the study. The number of positive cases increased with increasing resident number, and decreased in families with parents with a higher educational level. Itching was the principal clinical manifestation and caused sleep compromise in 65% of respondents. Innocuous and unhealthy practices to combat infestation, such as the use of inflammables and home insecticides, were common. CONCLUSION: The results showed that certain beliefs generated worry and confusion in parents, who blamed head lice as the cause of various health problems which were not due to this insect.

Prevalence and monthly distribution of head lice using two diagnostic procedures in several age groups in Uberlândia, State of Minas Gerais, Southeastern Brazil.

Some epidemiological characteristics of head lice, Pediculus capitis, were studied using two procedures: cut hair analysis and head inspection. Higher prevalence rates were observed in the middle and at the end of the school terms. Both procedures indicated that children were the main reservoir for this type of pediculosis in Uberlândia.