![]() and European consensus guidelines based on epidemiologic data and case studies The classic burrows in webs and creases may not be present. Scabies should be considered in patients with a pruritic, papular rash in the typical distribution and pruritus in close contacts. and Canadian consensus guidelines based on basic knowledge of the lice life cycle Inappropriate retreatment may result in resistance and lack of treatment effectiveness Some authors postulate that three treatments with permethrin or pyrethrins might be most effective. Nonovicidal therapies for pediculosis should be applied twice, seven to 10 days apart, to fully eradicate lice. consensus guidelines balancing effectiveness and toxicity Alternative treatments should not be used unless permethrin fails after two treatments. ![]() Permethrin 1% lotion or shampoo (Nix) is first-line treatment for pediculosis. and Canadian consensus guidelines based on basic knowledge of the lice life cycle Children should not be kept out of school during treatment, even with active infestation, because the likelihood of transmission is low, and this can result in significant absences. Counseling regarding appropriate diagnosis and correct use of effective therapies is key to reducing the burden of lice and scabies.Ī “no-nit” policy is not recommended for schools and day cares because nits alone do not indicate an active infestation. Clothing and bedding of persons with scabies should be washed in hot water and dried in a hot dryer. First-line treatment for scabies is permethrin 5% cream. In infants, the rash can also be vesicular, pustular, or nodular. Scabies in adults presents as a pruritic, papular rash in a typical distribution pattern. Body lice infestation should be suspected in patients with pruritus who live in crowded conditions or have poor hygiene. In adults, the presence of pubic lice should prompt an evaluation for sexually transmitted infections. Extensive environmental decontamination is not necessary after pediculosis is diagnosed. Noninsecticidal agents, including dimethicone and isopropyl myristate, show promise in the treatment of pediculosis. Newer treatments are available but costly, and resistance patterns are generally unknown. First-line pharmacologic treatment for pediculosis is permethrin 1% lotion or shampoo. A “no-nit” policy for return to school is not recommended because nits can remain even after successful treatment. Nits (lice eggs or egg casings) alone are not sufficient to diagnose a current infestation. Head and pubic lice infestations are diagnosed with visualization of live lice. Pruritus is the most common presenting symptom. Pediculosis and scabies are caused by ectoparasites.
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