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Pediatrics1248 papers

Pediculosis and phthirus infections

Last edited: 4/23/2026

Overview

Pediculosis (lice infestation) and phthirus infections (scabies) are parasitic skin conditions caused by lice and mites, respectively, leading to pruritus and potential secondary infections. 1029

Diagnosis

  • Clinical presentation: Pruritic rash, visible parasites, or eggs (nits).
  • Physical examination: Thorough skin inspection, especially in areas typical for each parasite (e.g., scalp for head lice, interdigital spaces for scabies).
  • Diagnostic tools: Microscopic examination of collected lice or mites and their eggs.
  • Differential diagnosis: Other pruritic dermatoses (eczema, dermatitis herpetiformis). 1029
  • Management

  • First-line treatments:
  • - Pediculosis: Topical permethrin or malathion, oral ivermectin for severe or resistant cases. - Phthirus infections: Topical permethrin or crotamiton, oral ivermectin for widespread or resistant cases.
  • Adjunctive measures:
  • - Environmental decontamination: Wash bedding and clothing in hot water, vacuuming for scabies. - Repeat treatment: Follow-up treatment may be necessary after 7-10 days to address newly hatched lice or mites. 1029

    Special Populations

  • Pregnancy: Use topical treatments like permethrin cautiously; avoid systemic treatments unless absolutely necessary and under strict medical supervision. 210
  • Pediatrics: Same treatments as adults but with careful application to avoid ingestion or inhalation of topical agents.
  • Elderly: Consider reduced skin integrity and potential for secondary infections; monitor for adverse reactions to treatments. 1029
  • Comorbidities: Patients with compromised immune systems may require more aggressive treatment and longer follow-up periods. 29
  • Key Recommendations

  • Diagnose based on clinical presentation and microscopic examination of collected specimens. (Evidence: Moderate) 10
  • Initiate treatment with topical permethrin for both pediculosis and phthirus infections, reserving oral ivermectin for severe or resistant cases. (Evidence: Moderate) 10
  • Ensure thorough environmental decontamination, including washing of bedding and clothing in hot water, to prevent reinfestation. (Evidence: Expert opinion) 10
  • In pregnant women, prioritize topical treatments and consult guidelines for safe use during pregnancy. (Evidence: Expert opinion) 2
  • Monitor pediatric and elderly patients closely for adverse reactions and secondary infections post-treatment. (Evidence: Moderate) 1029
  • References

    Showing 100 most recent of 196 indexed papers.

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Public health 2021. link 33 Bahdila D, Aldosari M, Cordes J, Klevens RM. Emergency department visits for infectious oral conditions in Massachusetts, 2014 through 2018. Journal of the American Dental Association (1939) 2021. link 34 Ramírez JM, Varela-Montes L, Gómez-Costa D, Giovannini G, Romero-Maroto M, Gómez de Diego R. Management of odonto-stomatological emergencies during the COVID-19 alarm state in dental clinics in the Autonomous Community of Madrid (CAM), Spain: An observational study. Medicina oral, patologia oral y cirugia bucal 2021. link 35 Bothra A, Maheswari A, Singh M, Pawar M, Jodhani K. Cutaneous manifestations of viral outbreaks. The Australasian journal of dermatology 2021. link 36 Midtgaard Eriksen C, Lauridsen Kujabi M, Sulaiman Kanu A, Gulis G. Health Perceptions in Relation to Child Health and Mortality in a Rural Context, Sierra Leone: A Mixed Method Study. 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