Pediculosis capitis. One of the first indications of infestation is intense itching. Pruritus indicates infestation of about two months' duration. The lice are difficult to see in clean individuals who have only a minor infestation. Yet they can be abundant and easily, seen in malnourished individuals with poor hygiene. Nits can be confused with dandruff and may be distinguished from it with a magnifying glass. Also dandruff falls from the hair easily whereas nits firmly attach to it. It should also be distinguished from seborrhea, psoriasis, the shafts which cover the hair in the pityriasis sicca or from the residual particles of hair spray. On examination of hairy skin, it is possible to see lichenification and severe scratching marks and erythema, especially in the occipital or retroauricular regions (Fig. 41.4). If a white cloth is place under the head of an infested child and a fine-toothed comb is drawn through the hair, lice, easily nits or ova, and a black powder-like lice feces will fall. Impetigo, folliculitis or furunculosis are frequently
associated with this infestation. Furunculosis can be accompanied by fever, malaise and regional adenopathy.
Pediculosis corporis. Papular lesions, scabs, hives, and scratch marks are seen. As with pediculosis capitis, symptoms begin only after several weeks of infestation or sooner in cases of reinfestation (Fig. 41.5). Pruritis is the main symptom, although with secondary infection there may be pain, fever, malaise and lymphadenopathy. To confirm the diagnosis, meticulous examination of the clothing will reveal lice and nits.
Pediculosis pubis. Pubic lice cause severe pruritus that is difficult to ignore. Examination reveals the black powder-like louse feces as well as mites firmly adherent to hair in the pubic and abdominal areas. Small blue-black dots caused by the irritating secretion of the lice's bite (macula cerulea) are characteristic. In hirsute individuals infestation may spread to the perianal and gluteal area, axilla, chest, back and umbilicus. It may also involve the beard and mustache. Children can become infested by sleeping with their parents or other affected people, not necessarily by sexual transmission. In children the common areas of involvement are the eyebrows and eyelashes (pediculosis ciliaris). It can cause blepharoconjuntivitis with epitheliopathy (Br J Ophtalmol 1993; 77:81516), as well as other ocular inflammations. The patient has intense pruritus, burning or pain. (Arch Dermatol 1973; 107:916-17).
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Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.