Phthirus pubis Infestation of the Scalp: A Case Report and Review of The Literature.

Phthirus pubis usually infests the pubis, groin, buttocks and perianal region. It can sometimes infest the thighs, abdomen, chest, axillae and beard. Eyelashes and eyebrows may be involved in children. The involvement of the scalp is very rare. We describe a case of P. pubis infestation located exclusively on the scalp in an adult woman. Neither lice/nits nor skin lesions were observed elsewhere, including eyebrows, eyelashes, axillae, pubis, buttocks and perianal region (the patient was hairless in the axillae and pubis). A review of the literature is enclosed.

Un caso de prurito incoercible / A case of incoercible pruritus

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Case of Phthiriasis palpebrarum with blepheroconjunctivitis.

A 70-year-old woman came to ophthalmology outpatient department with complaints of repeated episodes of itching, redness and watering in both eyes of 3 months duration. She was treated with antibiotics elsewhere but had no improvement. Slit lamp examination showed lice and nits anchored to the eyelashes. Light microscopic examination of the matted eye lashes and crusts further helped in identification of the ectoparasites as Phthirus pubis (Pubic louse or Crab louse) with typical morphology.

[Phthiriasis palpebrarum: diagnosis and treatment]. / Phthiriasis palpebral: diagnóstico y tratamiento.

Phthiriasis palpebrarum, caused by Phthirus pubis, is an uncommon cause of blepharoconjunctivitis; therefore, this condition is easily misdiagnosed. When diagnosed, genital involvement must be ruled out. Association with other venereal diseases is common. Affected children must be searched for sexual abuse. The number of diagnosed patients in our department has increased in recent years. We review the epidemiological, clinical and diagnostic features of phthriasis palpebrarum as well as the different treatment options to eradicate the parasite and to prevent infestations.

Phthiriasis palpebral / Phthiriasis of the eye-lid

La phthiriasis palpebral es una causa poco común de blefaritis y conjuntivitis que puede fácilmente ser omitida por el oftalmólogo. Un alto índice de sospecha y un cuidadoso examen en la lámpara de hendidura sobre las pestañas y márgenes palpebrales del paciente lleva a un diagnóstico certero. Aunque los piojos pueden ser difíciles de detectar, la acumulación de liendres (larvas del piojo) y de las heces de los piojos sobre las pestañas, que se aprecian como un material granular rojizo marrón en la base de las pestañas, ayuda a realizar el diagnóstico. La pediculosis se transmite por contacto íntimo con individuo infestado por vestidos y ropas de cama contaminadas, la otra forma de transmisión es típicamente por contacto sexual. En los niños la infestación puede ser debida al contacto íntimo con la madre o niñera. Pestañas y cejas son los sitios de predilección. En los adultos la phthiriasis palpebral es probablemente transmitida del área genital a los ojos mediante la mano. El tratamiento medicamentoso debe acompañarse de una cuidadosa remoción de los piojos y liendres de las pestañas del paciente. La aplicación local de pediculicidas tales como: fluoresceína al 20 por ciento, ungüento de óxido de mercurio amarillo al 1 por ciento, petrolato de fisostigmina, lociones de hexacloruro de gamma benceno, malatión, carbaryl y permetrina, o el uso de crioterapia y láser de argón. Miembros familiares, contactos sexuales, compañeros íntimos deben ser examinados y tratados, vestidos, ropas artículos personales deberán ser desinfectados a una temperatura de 50 grados centígrados por 30 minutos.

Infestación de los párpados de un niño por phthirus pubis / Eyelids infestation by phthirus pubis in a boy

A clinical case of phthirus pubis infestation of the eyelids in an eight year old boy is presented. He complained of a bilateral eyelids inflammation for the last two weeks which had not healed with a daily application of a collyrium. Physical examination showed the presence of small dark spheres, of approximately 1 mm. attached to the proximal extreme of the eyelashes. A microscopical examination of these elements permitted to identify adults and eggs of P. pubis. Neither insects nor eggs were found in the scalp of the patient. Treatment consisted in the extraction of the parasite elements by means of a fine forceps after the application of liquid vaseline in the eyelashes. A total of 23 adults insects and 32 eggs was removed. The boy proceeded from a boarding school, where none of the other 27 children was found infested and stayed there form monday to friday, going home for week ends. It was impossible to contact the mother, the most probable source the patient infestation, for epidemiological and prophylactical purposes