Itchy scalp

Based on the patient’s history, the FP suspected that this was a case of either head lice or seborrhea. He put on gloves to examine the hair and found nits (eggs) glued to the hair. There was an especially high density of them behind her ears (which is always a good place to begin the exam for head lice). The nits were pearly as expected, but no live adult head lice were found.

The FP was aware that nits are far more numerous than adult head lice. The scalp itself was unremarkable and there was no seborrhea. While it is possible to look at nits under a microscope to see if there are live larvae inside, the history of 2 weeks of symptoms without treatment was sufficient to assume that this was an active case of head lice, rather than dead or hatched nits from a previous case.

The mother confirmed that the child hadn’t been treated for head lice in the past and claimed that she washed her daughter's hair every night. The FP explained that any child in school or around other children can easily get head lice—regardless of their personal hygiene habits. The FP asked if it was okay to check the mother’s hair, and found a few nits behind her ears, as well.

There are many treatment options for head lice, including 2 nonprescription products that cost less than $15 each: 1% permethrin cream rinse (Nix) and pyrethrins with piperonyl butoxide (RID) shampoo. There are also more expensive prescription products, including malathion 0.5%, benzyl alcohol 5% lotion, spinosad, and ivermectin 0.5% lotion. A 2001 Cochrane review found no evidence that any one pediculicide was better than another.¹ However, the review only included studies of permethrin, synergized pyrethrin, and malathion.

In this case, the mother chose to buy the over-the-counter 1% permethrin cream rinse for herself and her daughter. While the FP was not able to examine the patient’s father or older brother, he did suggest that they all do the treatment simultaneously to avoid one family member remaining infested (and then reinfesting the rest of the family).

1. Dodd CS. Interventions for treating headlice. Cochrane Database Syst Rev. 2001;CD001165.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ, Usatine R. Lice. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 570-574.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

Based on the patient’s history, the FP suspected that this was a case of either head lice or seborrhea. He put on gloves to examine the hair and found nits (eggs) glued to the hair. There was an especially high density of them behind her ears (which is always a good place to begin the exam for head lice). The nits were pearly as expected, but no live adult head lice were found.

The FP was aware that nits are far more numerous than adult head lice. The scalp itself was unremarkable and there was no seborrhea. While it is possible to look at nits under a microscope to see if there are live larvae inside, the history of 2 weeks of symptoms without treatment was sufficient to assume that this was an active case of head lice, rather than dead or hatched nits from a previous case.

The mother confirmed that the child hadn’t been treated for head lice in the past and claimed that she washed her daughter's hair every night. The FP explained that any child in school or around other children can easily get head lice—regardless of their personal hygiene habits. The FP asked if it was okay to check the mother’s hair, and found a few nits behind her ears, as well.

There are many treatment options for head lice, including 2 nonprescription products that cost less than $15 each: 1% permethrin cream rinse (Nix) and pyrethrins with piperonyl butoxide (RID) shampoo. There are also more expensive prescription products, including malathion 0.5%, benzyl alcohol 5% lotion, spinosad, and ivermectin 0.5% lotion. A 2001 Cochrane review found no evidence that any one pediculicide was better than another.¹ However, the review only included studies of permethrin, synergized pyrethrin, and malathion.

In this case, the mother chose to buy the over-the-counter 1% permethrin cream rinse for herself and her daughter. While the FP was not able to examine the patient’s father or older brother, he did suggest that they all do the treatment simultaneously to avoid one family member remaining infested (and then reinfesting the rest of the family).

1. Dodd CS. Interventions for treating headlice. Cochrane Database Syst Rev. 2001;CD001165.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ, Usatine R. Lice. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 570-574.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

Based on the patient’s history, the FP suspected that this was a case of either head lice or seborrhea. He put on gloves to examine the hair and found nits (eggs) glued to the hair. There was an especially high density of them behind her ears (which is always a good place to begin the exam for head lice). The nits were pearly as expected, but no live adult head lice were found.

The FP was aware that nits are far more numerous than adult head lice. The scalp itself was unremarkable and there was no seborrhea. While it is possible to look at nits under a microscope to see if there are live larvae inside, the history of 2 weeks of symptoms without treatment was sufficient to assume that this was an active case of head lice, rather than dead or hatched nits from a previous case.

The mother confirmed that the child hadn’t been treated for head lice in the past and claimed that she washed her daughter's hair every night. The FP explained that any child in school or around other children can easily get head lice—regardless of their personal hygiene habits. The FP asked if it was okay to check the mother’s hair, and found a few nits behind her ears, as well.

There are many treatment options for head lice, including 2 nonprescription products that cost less than $15 each: 1% permethrin cream rinse (Nix) and pyrethrins with piperonyl butoxide (RID) shampoo. There are also more expensive prescription products, including malathion 0.5%, benzyl alcohol 5% lotion, spinosad, and ivermectin 0.5% lotion. A 2001 Cochrane review found no evidence that any one pediculicide was better than another.¹ However, the review only included studies of permethrin, synergized pyrethrin, and malathion.

In this case, the mother chose to buy the over-the-counter 1% permethrin cream rinse for herself and her daughter. While the FP was not able to examine the patient’s father or older brother, he did suggest that they all do the treatment simultaneously to avoid one family member remaining infested (and then reinfesting the rest of the family).

1. Dodd CS. Interventions for treating headlice. Cochrane Database Syst Rev. 2001;CD001165.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ, Usatine R. Lice. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 570-574.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com