Assessment of the Prevalence of Head Lice Infestation and Parents' Attitudes Towards Its Management: A School-based Epidemiological Study in Istanbul, Türkiye

OBJECTIVE: Head lice infestation (HLI), caused by Pediculus humanus capitis, is an important public health problem worldwide, especially in primary school children. The aim of this study is to investigate HLI level, related factors, and families' knowledge levels and attitudes about HLI in two primary schools in a relatively low socio-economic region in Istanbul. METHODS: A questionnaire on HLI was developed initially and delivered to all children and parents in the school. A total of 340 primary school students, aged between 6-12, were enrolled in the study after the consent of their parents. Their hair were examined for HLI with special combs at their schools, and free anti-lice shampoos were given to parents of positive children. A total of 951 completed questionnaires were received and evaluated with chi-square test using the SPSS® 17.0 program, and the differences of p<0.05 were considered significant. RESULTS: Number of boys in the study was slightly higher than the girls (176 vs. 164). HLI was detected in 32 (9.4%) of 340 children; seven had live adult lice on their hair while 25 had only the nits. HLI was obviously more common in girls (16.4%), compared to boys (2.8%). Analysis of 951 questionnaires revealed a statistically significant difference between HLI and infrequent bathing (p<0.05). The differences between HLI and the education levels of parents, income, the number of siblings and in contact with animals were not found to be significant (p>0.05). CONCLUSION: HLI is still a common health problem, especially in girls in primary schools. Parents are aware of the relationship between the hygiene and prevention against HLI, but low socio-economic resources seem to be important determinants. Regular combing and training activities in primary schools, in coordination with the local authorities and parents are no doubt useful in reducing the incidence of HLI among the children.

Prevalence of Pediculosis Among Primary School-Aged Students in Iran: an Updated Comprehensive Systematic Review and Meta-Analysis.

In this study, a systematic investigation was performed to estimate the prevalence of head lice infestation, and to determine the factors affecting the prevalence of heterogeneity among primary school-aged children in Iran. A comprehensive search was fulfilled in international databases, including MEDLINE, Scopus, Web of Science, and Embase, to identify the articles on the prevalence of pediculosis. So, all the cross-sectional epidemiological studies evaluating the prevalence of pediculosis were covered without any restrictions. A random-effects model was used to assess the pooled prevalence. A meta-regression method was applied to determine the factors affecting the heterogeneity among the studied population. An analysis was performed on 67 studies with a total sample size of 358,053. The total pooled estimate for the prevalence of pediculosis in boys and girls was 7.52% (95% CI: 6.15-9.03), 1.99% (95% CI: 1.25-2.89), and 8.97% (95% CI: 721-10.91), respectively. The highest and lowest pooled prevalence was in Hormozgan (southern Iran) (29.21%; 95% CI: 8.89-55.34) and Isfahan (Central Iran) (0.69%; 95% CI: 0.59-0.80), respectively. Based on the results of the univariate meta-regression, gender and father's job showed a significant direct association with the prevalence of pediculosis, but the sample size had significant inverse relations with the prevalence of pediculosis. This study demonstrated that pediculosis is a common public health problem affecting school-aged children with a relatively high prevalence in Iran, especially among girls.

Impact of a health educational interventional program on reducing the head lice infestation among pupils in an elementary school of a sub-tropical region: a quasi-experimental study.

BACKGROUND: Pediculosis is an important social challenge that can be caused by human head louse, Pediculus humanus capitis. This infestation is cosmopolitan, especially in countries with low hygiene and sanitation. Regular health education classes for students and their parents are required to reduce this infestation in schools and families. This study aimed to evaluate the impact of a health education intervention program on reducing head lice among pupils of an elementary school. METHODS: In a quasi-experimental study, a total of 880 elementary school girls were screened for pediculosis in (2017-2018). The prevalence of pediculosis follow-up continued monthly until the end of the school year after a two months educational intervention course. Visual inspection was applied for initial diagnosis of infection. The suspected cases were confirmed by wood lamp and potassium hydroxide (KOH) microscopic examination. Also eight questions about diagnostic, epidemiology, treatment and prevention were answered in a questionnaire by 50 volunteer parents before and after the training intervention course, to evaluate their general knowledge and measure the effectiveness of learning. All data were statistically analyzed using SPSS software (version 20.0, SPSS, Inc., Chicago, IL, USA). McNemar's test was also applied to investigate the prevalence rate before and after the intervention. A p -value of less than 0.05 was considered as statistically significant. RESULTS: At the beginning of study, pre-intervention prevalence of pediculosis among pupils was 8.4% (49/594). The mean age in all pupils was 9.86 ± 1.83 years old and the most infestation was shown in fourth-grade students with 10 years old. Analysis of statistics demonstrated a significant difference between having infestation and the number of members in the families. Post-intervention phase led to a decreased prevalence of pediculosis in pupils to 3% (8/594) (p-value < 0.05). Based on statistical analysis of questions before and after the training in the questionnaire, a significant increase of parental knowledge was observed on the prevention program of pediculosis (p-value < 0.001). CONCLUSION: The prevalence of pediculosis was significantly reduced following the educational interventions in the school. The applied interventions may be implemented in other residual centers to get rid of this important infestation.

Demographic, clinical and dermoscopic features of melanocytic nevi on the scalp.

BACKGROUND: The scalp is a special anatomical area and dermoscopic findings of this region may significantly differ from other body parts. OBJECTIVE: To investigate and compare the clinical and dermoscopic patterns of scalp melanocytic nevi in patients ≤15 years of age and above, and to analyse their relevance to demographic features, atypical mole syndrome (AMS) and total body nevus count (TBNC). METHODS: In this retrospective cohort study, the clinical data and dermoscopic images of patients with scalp melanocytic nevi were retrieved, reviewed and analysed. Demographic, clinical and dermoscopic features were compared in patients ≤15 years of age and above. RESULTS: A total of 196 scalp melanocytic nevi in 126 patients (female/male:64/62; ≤15/>15 years of age: 49/77) with a median age of 18.5 years (range 0-72) were evaluated. Statistically, the globular pattern was significantly higher in all age groups, and the papillomatous pattern was significantly lower in patients ≤15 years of age (P = 0.008 and P = 0.005, respectively). The eclipse pattern was significantly higher, and the homogenous pattern was significantly lower in patients ≤15 years of age with AMS (P = 0.003 and P = 0.014, respectively). Finally, patients ≤15 years of age with 50 to 100 TBNC had a higher eclipse pattern than those with 0 to 25 TBNC. CONCLUSION: The findings of this retrospective study might implicate that children with eclipse pattern of scalp melanocytic nevi might be 'moley' in the future with an impending risk of AMS. This hypothesis requires confirmation in future prospective studies on a larger cohort of patients.

Scalp involvement in patients referred for patch testing: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data, 1996 to 2016.

BACKGROUND: Scalp conditions are often multifactorial. OBJECTIVE: To characterize patients with scalp involvement and patch-testing outcomes. METHODS: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data (1996-2016). Study groups included patients with scalp involvement (≤3 anatomic sites coded) with or without additional sites. RESULTS: A total of 4.8% of patients (2331/48,753) had scalp identified as 1 of up to 3 affected anatomic sites. Approximately one-third of "scalp-only" individuals had a specific primary diagnosis of allergic contact dermatitis (38.6%), followed by seborrheic dermatitis (17.2%) and irritant contact dermatitis (9.3%). When adjacent anatomic sites were affected, allergic contact dermatitis was more frequently identified as the primary diagnosis (>50%). The top 5 currently clinically relevant allergens in scalp-only patients were p-phenylenediamine, fragrance mix I, nickel sulfate, balsam of Peru, and cinnamic aldehyde. Methylisothiazolinone sensitivity was notable when adjacent anatomic sites were involved. The top 3 specifically identified sources for scalp-only allergens were hair dyes, shampoo/conditioners, and consumer items (eg, hair appliances, glasses). LIMITATIONS: Tertiary referral population. CONCLUSION: Isolated scalp involvement was less likely to be associated with allergic contact dermatitis than when adjacent anatomic sites were involved. Overlap with multiple diagnoses was frequent, including seborrheic dermatitis, irritant dermatitis, other dermatoses, or all 3. p-Phenylenediamine was the most common allergen.

International recommendations for an effective control of head louse infestations.

Head louse infestations continue to be a concern of public health in most countries, including the most developed ones. The present recommendations are intended to inform and stress the role and impact of the different authorities, institutions, industry, and the public in the control of head lice in order to reduce the prevalence of this parasite. We encourage health authorities to pursue more effective methods to correctly identify such infestations, and evaluate existing and new pediculicides, medical devices, louse repellents, and louse- and nit-removal remedies. Pediculicides and medical devices must have verifiable claims in the instructions for use and should be tested periodically to document current levels of resistance by lice to the active ingredients and to the formulated products. Where the prevalence of lice is claimed to be epidemic, children should be periodically evaluated objectively to document the actual level of prevalence. Continuing education for health providers and the general population promises to correct misinformation regarding the biology, prevention, and management of lice. Parents should regularly inspect their children for head lice and treat as necessary. Health authorities are encouraged to eliminate policies and practices that rely upon school exclusion as a means to reduce incidence and prevalence, e.g., the 'no-nit' policy which lacks scientific justification, and are counterproductive to the health and welfare of children.

Contact allergy to hair-colouring products: a cosmetovigilance follow-up study by four companies in Europe from 2014 to 2017.

BACKGROUND: A previous analysis of undesirable events (UEvs), reported to four major companies following the use of hair-colouring products in Europe, showed that the reporting rates were stable for both oxidative and direct hair-colouring products over the period 2003-2006. OBJECTIVES: In order to verify the impact of risk management measures implemented since 2006, as well as the impact of a new Commission Regulation (No 1223/2009), the same four companies analysed cosmetovigilance data collected over an additional four-year period (2014-2017). The objective was to determine whether there was any time effect, country effect, or product type effect, as well as identify risk factors. MATERIALS AND METHODS: Each company collected reports of alleged UEvs, undesirable effects (UEfs) and serious undesirable effects (SUEs) for their products in their key European markets, and calculated the respective reporting rates (number of events/million units sold). A detailed analysis was performed on allergic contact dermatitis-type events. RESULTS: The reporting rates for alleged UEvs and allergic-type UEfs associated with hair-colouring products remained stable over the four-year period, although a statistically significant decrease was observed for some companies. No time effect on SUEs was observed for three companies but a statistically significant decrease in SUEs was observed for one company. Black henna tattoos remained a major risk factor regarding SUEs due to hair dyes. CONCLUSION: The reporting rates of undesirable events, including contact allergy-type events, were stable over time. This was true for oxidative and direct hair dyes, for both home use and professional exposure scenarios.

Evaluation of the effects of COVID-19 pandemic on hair diseases through a web-based questionnaire.

AIM: Current quarantine conditions are a difficult process for individuals and can worsen the psychological state. Increased psychosocial stress can affect the course of many common "stress-sensitive" skin conditions. This study examined the possible effects of coronavirus disease 2019 (COVID-19) on hair and scalp diseases such as telogen effluvium (TE), alopecia areata (AA), and seborrheic dermatitis (SD) in individuals who had to stay at home for a long time and the patients' methods of dealing with these diseases. METHODS: The study was conducted using an online questionnaire. All the individuals were asked questions about pre- and post-pandemic TE, AA, and SD. Participants with complaints were asked what they did for treatment. RESULTS: During the pandemic, TE was seen in 27.9% of the participants, AA on the scalp was seen in 2.8%, AA on the face was seen in 2.5%, and SD was seen in 19.9%. Applying to a dermatologist for complaints during the pandemic was lower than before pandemic. TE was higher in women before and during the pandemic. CONCLUSION: It was found that the rates of referring to a dermatologist for the complaints before the pandemic varied between 15% and 28% and that these rates decreased significantly during the pandemic (2.5%-12.5%).

[Scalp disorders in black Africans treated in a dermatology department in Cotonou (Benin): age-sex-specific epidemiological and clinical features]. / Pathologies du cuir chevelu chez le Noir africain en dermatologie à Cotonou (Bénin): aspects épidémiologiques et cliniques en fonction du sexe et de l´âge.

INTRODUCTION: scalp disorders are related to several factors including ethnicity, gender or age. In black people, they can be caused by intrinsic and extrinsic factors. Very few studies have been conducted in this ethnic group residing in black Africa, hence the purpose of our survey was to highlight the epidemiological and clinical features of age-sex-specific scalp disorders in patients treated in a dermatology department in Cotonou (Benin). METHODS: we conducted a retrospective and descriptive study of all the medical records of new patients coming to consultation in the dermatology department at the National Hospital and University Center (CNHU) of Cotonou over a period of seven years. The main reason for consultation was scalp disorder. Data on epidemiological and clinical features were collected and analyzed with the EPI-Info 7 software. RESULTS: prevalence of scalp disorders was 2.4% (181/7554). Children (0-18 years) accounted for 38.7% (70 patients) and adults 61.3% (111 patients). Children aged 0-10 (54; 29.8%) and adults aged 25-40 (51; 28,2%) were the most affected. Sex ratio was 1.8. Non-alopecizing dermatosis was diagnosed in 10; 5.5% of cases while alopecizing dermatosis in 171 patients (94.5%), of whom 82.9% (151/171) had non-scarring dermatosis and 11.7% (20/171) had scarring dermatosis. The most common conditions were ringworm (41; 22.6%), mainly occurring in 0-10-year-old boys, chronic non-scarring folliculitis (39; 21.5%) mainly occurring in 0-5-year-old boys and 19-40-year-old men, pelade (38; 21%) occurring in both male and female sexes, especially between the ages of 6-10 and 25-40, traction alopecia (17; 9.4%) occurring exclusively in women and mainly in the 25-40-year-old age group, fibrous folliculitis at the nape of the neck (12; 6.6%) occurring exclusively in men from 19 to 50 years, trichotillomania (9; 5%) occurring in both male and female sexes, mainly in children aged 6-10 years and in adults aged 25-40 years, Quinquaud folliculitis decalvans (6; 3.3%) occurring uniformly in both male and female sexes and mainly between 25-40 years of age. CONCLUSION: scalp disorders mainly affect male patients before puberty and young adults. They were arranged in descending order in non-scarring alopecizing dermatoses, scarring alopecia and non-alopecizing dermatoses.

Ectoparasites: Pediculosis and tungiasis.

Pediculosis is an infestation of lice on the body, head, or pubic region that occurs worldwide. Lice are ectoparasites of the order Phthiraptera that feed on the blood of infested hosts. Their morphotype dictates their clinical features. Body lice may transmit bacterial pathogens that cause trench fever, relapsing fever, and epidemic typhus, which are potentially life-threatening diseases that remain relevant in contemporary times. Recent data from some settings suggest that head lice may harbor pathogens. The epidemiology, clinical manifestations, and management of body, head, and pubic louse infestation are reviewed. New therapies for head lice and screening considerations for pubic lice are discussed. Tungiasis is an ectoparasitic disease caused by skin penetration by the female Tunga penetrans or, less commonly, Tunga trimamillata flea. It is endemic in Latin America, the Caribbean and sub-Saharan Africa and seen in travelers returning from these regions. Risk factors for acquiring tungiasis, associated morbidity, and potential strategies for prevention and treatment are discussed.

Contact allergy to hair cosmetic allergens in Thailand.

BACKGROUND: Hair cosmetics such as hair dyes, bleaching, waving, and cleansing products are composed of numerous chemical ingredients. Allergic reactions to these contact allergens, other than p-phenylenediamine, are rarely reported. OBJECTIVES: To study the incidence of patch test reactions to hair cosmetic allergens and identify the factors associated with hair cosmetic allergy in Thailand. METHODS: We retrospectively reviewed the case records of patients who underwent patch testing from 2009 to 2018. Patients with at least one positive patch test reaction to a potential contact allergen associated with hair cosmetic ingredients were studied. RESULTS: Overall, 2842 patients were patch tested. Of the hair cosmetic allergen categories, preservatives had the highest rate of positive reactions, followed by surfactants and hair dyes. Perming agents were less problematic in comparison. The hands, head, and neck were the predominately affected sites of allergic reactions to hair cosmetic ingredients. CONCLUSIONS: Preservatives, surfactants, and hair dyes are important contact allergens, whereas perming agents are less likely to cause allergic reactions. Hair cosmetic ingredients are regulated by national agencies, which influences their extent of exposure and rates of contact allergies. Further continuous observation of hair cosmetic allergy is needed to provide the best patient care.

[Children with psoriasis in secondary care: Clinical aspects and comorbidities diverge from the generally published data]. / Psoriasis de l'enfant vu en milieu libéral : les aspects cliniques et épidémiologiques diffèrent des données habituellement publiées.

BACKGROUND: Psoriasis affects 0.2-0.7 % of children and is associated with obesity. Published studies have been conducted in hospital settings (tertiary care). The PsoLib study evaluated childhood psoriasis in private practice (secondary care) in terms of epidemiology, clinical aspects and comorbidities. PATIENTS AND METHODS: This was a non-interventional, cross-sectional, multicenter study of children with psoriasis performed by 41 dermatologists working in private practice. The clinical and therapeutic aspects and comorbidities were systemically evaluated. We compared data to the χ-Psocar study performed in hospitals using the same methodology. RESULTS: In all, 207 children (girls: 60.4 %; mean age: 10.5±4.2 years) were included. Scalp psoriasis (40.6 %) was the most frequent clinical type, while plaque psoriasis represented 26 % of cases. Nail, tongue, and arthritic involvement were rare. Less than 1 % of children suffered from hypertension, diabetes or dyslipidemia, but 16.4 % were overweight and 7.0 % were obese. Severity (PG≥4 at peak) was associated with excess weight (P=0.01). CONCLUSION: Scalp psoriasis is the most frequent clinical type of psoriasis in childhood. Comorbidities and extracutaneous localization are rare. Even in private practice, the severity of the disease is associated with excess weight.

Distribution of atopic dermatitis lesions in United States adults.

BACKGROUND: The distribution of atopic dermatitis (AD) lesions and its impact on quality of life (QOL) is not well established in the US adult population. OBJECTIVE: To elucidate the distribution of AD lesions and its impact on QOL in US adults with AD. METHODS: A cross-sectional, population-based study of 602 adults was performed. AD was determined using modified UK Diagnostic Criteria, and its lesional distribution was assessed. QOL was assessed using Dermatology Life Quality Index (DLQI). Latent class analysis (LCA) was used to determine distinct phenotypes of AD lesional distribution. Multivariable logistic regression was used to determine the relationship between DLQI and distinct phenotypes. RESULTS: The most common sites of skin lesions were reported to be the popliteal fossae, lower legs, dorsal feet and antecubital fossae. Most persons reported partial (19.0%) or complete (63.0%) symmetry of lesions on the extremities. Lesions on the trunk were significantly more common in blacks and Hispanics. Age ≥ 60 years was associated with significantly lower proportions of active lesions on the face and scalp, and significantly higher proportion of lesions on the buttocks or genitals. LCA identified 5 classes of lesional distribution: 1. lower probabilities of lesions affecting any sites; 2. Higher probability of lesions involving the anterior and posterior neck and trunk; 3. lesions involving the antecubital fossae and upper extremities; 4. lesions involving the arms, posterior hands, genitals and buttocks, and to a lesser extent face, palms and legs; 5. lesions affecting all sites. Class-2 (multivariable logistic regression; adjusted odds ratio [95% confidence interval]: 7.19 [3.21-16.07], class-3 (7.11 [3.20-15.80]), class-4 (6.90 [3.07-15.50]) and class-5 (7.92 [3.54-17.71]) were all significantly associated with higher DLQI scores compared to class 1. CONCLUSION: AD is associated with heterogeneous distribution of AD lesions, and distinct phenotypes that are associated with QOL impact.

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.

National and Provincial Prevalence of Pediculus humanus capitis among Urban Students in Iran from 2014 to 2018.

BACKGROUND: Pediculosis capitis is one of the most common contagious diseases in overcrowded places, especially in schools. We aimed to determine the overall and seasonal prevalence of Pediculosis capitis (head lice infestation) among Iranian students. STUDY DESIGN: A repeated cross-sectional study. METHODS: The present study was conducted among all students, aged 6-18 yr, from urban areas of 31 provinces of Iran from 2014 to 2018. The student's hair and scalp were examined by trained school health instructor. The prevalence (95% Confidence Interval) of pediculosis were estimated overall and stratified by gender. Linear and Poisson regression models were used for data analysis. RESULTS: Results showed an upward trend of pediculosis from 1.7% to 3.42% during four years of study (P for trend=0.006). Overall, the prevalence of this infestation was significantly higher in girls than boys (P-value<0.05). The relative risk of head lice infestation in autumn was 2.42 times higher than spring (RR: 2.42, 95%CI: 1.35 to 4.32). CONCLUSION: Pediculosis is still a health issue among Iranian students, especially in girls. This infestation had upward trend in recent years and was more common in southern Iran. Increasing the awareness of students regarding symptoms and complications of pediculosis and using accurate diagnosis methods can be effective in reducing the prevalence of pediculosis and its consequences.