Pediculosis

Pediculosis, (Lat. pediculosis, from pedicu-lus-lice), or phthiriosis (from Gr. phthei-rein-to corrupt). Even before the mid-19th century, lice were seen as a "product of corrupted body juices"; this theory of "louse disease" collapsed as soon as Hebra (Hebra, 1865) and others showed that lice cannot live in closed cavities. Among skin diseases, pediculosis ranks second in prevalence in our country after scabies; it finds particularly favorable soil during national disasters (famine, war). Being a carrier of certain infectious diseases, lice (see) themselves, mainly due to the itching caused by their bites and the saliva entering the skin during sucking, often provoke skin changes, sometimes quite severe. The itching causes pinpoint and linear blood scratches, which are often infected with pyogenic cocci—pyoderma, furunculosis, impetiginous eczema, etc., develop. Depending on the type of louse and the location, one distinguishes in humans pediculosis of the hairy skin of the head (p. capitis), pediculosis of the body skin (p. corporis), and pediculosis of the pubic skin (p. pubis).- In pediculosis of the hairy skin of the head, the occipital and temporal regions are primarily affected; women and children are affected more often. Head lice attach their pear-shaped eggs (nits) to the hair shaft by means of a special chitinous sheath; eggs are always laid near the exit of the hair, where the temperature is higher and where they are better protected from damage. Due to bites, scratches, and excoriations, a moist-crusty (impetiginous) eczema develops. To this often join individual pustular eruptions on the face, moist dermatitis behind the ears, conjunctivitis, blepharadenitis, and swelling of the cervical and submandibular glands. Due to abundant serous-purulent discharge, the hair becomes glued together, forming a felt-like mass (plaque-plica polonica). The diagnosis of head pediculosis is difficult only in neat individuals; the presence of nits establishes the diagnosis. Every patient with occipital eczema should be carefully examined for the presence of lice or nits.- Treatment. The best remedies are kerosene and xylene, with which the head is rubbed (after being shaved beforehand), after which it is tied up for a short time; the drawbacks of these remedies are sometimes strong skin irritation (especially with xylene), bad smell (kerosene), and flammability of their vapors. In more or less complicated cases, the following are recommended: compresses for a day made of kerosene mixed with olive oil (a mixture can be used: 100 g kerosene, 50 g olive oil, and 10 g Peruvian balsam), Acet. Sabadillae, 10% oil solution of naphthalene, and others. After using these remedies, frequent washing of the head with hot water and soap is necessary, and, for the final removal of nits, frequent moistening of the hair with warm table vinegar, which dissolves the chitin with which the nits are attached to the hair; after the removal of lice and nits, the usual eczematous and other complications are eliminated. In pediculosis of the body skin, the body louse lives and lays eggs, mainly in the folds of underwear, from which it only transfers to the skin to obtain food (blood); therefore, the areas corresponding to the folds of clothing are most affected, mainly the lumbar region and the neck. In addition to scratches and pyoderma, body pediculosis usually leaves pigmentation of the affected areas (melanoderma) for many years, depending on the destruction of Hb in tissue hemorrhages caused by the action of lice saliva (Pavlovsky and Stein). In long-standing pediculosis, the pigmented skin of the affected areas becomes thicker and rougher (see Briadoga disease). The diagnosis may be difficult only in fresh cases; the localization allows avoiding error even in these cases. Pyoderma and furunculosis in the lumbar region are always suspicious of pediculosis.- Treatment consists of frequent soap baths, sulfur baths, and, above all: disinfection of underwear, clothing, bedding, and the dwelling. Complications are treated according to general rules. Great importance in the fight against pediculosis belongs to baths, in which, simultaneously with washing the louse-infested, their clothing and underwear are disinfected by high temperature and steam. In pediculosis of the pubic skin, the crab louse lives mainly on the skin of the pubis and the bordering parts of the abdomen and thighs, from which it can spread to other parts of the body covered with hair: chest, limbs, axillary fossae, mustache, beard, eyelashes, eyebrows, and in children also to the hairy skin of the head. Crab lice attach firmly with their proboscis to hair follicles and with their front legs to the hair. Scratches, pustules, and crusts are very rare. When localized in the axillary fossae, small red nodules and eczematization may appear. Often crab lice leave on the sites of bites peculiar, round spots, the size of a lentil to a bean, of pale blue to pale gray color—maculae caeruleae (taches bleues). These spots are due to the combination of crab lice saliva with the coloring substance of the blood, which has been confirmed experimentally: a day after the subcutaneous injection of a suspension of crushed crab lice, maculae caeruleae appear at the injection site. The diagnosis is difficult only in those rare cases when the maculae caeruleae spreading on the skin of the abdomen and chest take a reddish tint, then resembling a fading syphilitic or typhous roseola. By color, the blue spots can sometimes resemble the initial spots of anetoderma (atrophia cutis maculosa). Crab lice are infected, mainly, during sexual contact, but transfer is also possible through bed linen. - Treatment: washing with hot water and soap, followed by combing with a fine comb, eliminates most crab lice; for the final destruction of crab lice and nits, rubbing of a 1% solution of corrosive sublimate in glycerin or corrosive sublimate vinegar (1:300) is recommended. The favorite remedy is rubbing of mercurial ointment (popular name "politan"), which can cause severe dermatitis in mercury-sensitive individuals. One can rub 5-10% white mercuric precipitate ointment, 3-5% calomel ointment, petroleum, foam of afri-dol soap, and many others. When using mercurial ointments, it is necessary to monitor the oral cavity. Prevention. One must watch the cleanliness of the body and clothing. When in contact with louse-infested persons, mechanical and chemical protective measures can be used. The former include special long clothing (for medical personnel) made of rubber material or impermeable canvas; the latter—lubrication of the body with eucalyptus oil or alcoholic solution (10%) of bergamot oil; for mass prevention these oils are unsuitable due to their high cost; in such cases, frequent dusting of clothing and linen with naphthalene is recommended. Furthermore, rational boiling of linen in tar dissolved in water with alkali (tar smell repels lice) is recommended. The best prevention is raising the well-being and culture of the population and energetic struggle against pediculosis (see Bath-Laundry Service) in places of greatest concentration of people (dormitories, barracks, railway stations, etc.).