dermatologic disorders
Lice
Pubic lice
Pubic lice (“crabs”) are sexually transmitted in adolescents and adults and may be transmitted to children by close parental contact. They may also be transmitted by fomites (eg, towels, bedding, clothing). They most commonly infest pubic and perianal hairs but may spread to thighs, trunk, and facial hair (beard, mustache, and eyelashes). © Springer Science+Business Media Image provided by Thomas Habif, MD. Pubic lice may spread to the eyelashes. This photo shows eyelashes infested with a louse and nits. PAUL PARKER/SCIENCE PHOTO LIBRARY Maculae ceruleae are the blue spots in the thigh. They are thought to be secondary to anticoagulant activity of louse saliva. © Springer Science+Business Media © Springer Science+Business Media Louse excreta are the reddish brown dots on the skin. © Springer Science+Business Media © Springer Science+Business Media Pubic lice cause pruritus. Physical signs are few, but some patients have excoriations and regional lymphadenopathy and/or lymphadenitis. Pale, bluish gray skin macules (maculae ceruleae) on the trunk, buttocks, and thighs are caused by anticoagulant activity of louse saliva while feeding; they are unusual but characteristic of infestation. Eyelash infestation manifests as eye itching, burning, and irritation. Diagnosis of pubic lice is by demonstration of nits, lice, or both by close inspection (Wood lamp) or microscopic analysis. A supporting sign of infestation is scattering of dark brown specks (louse excreta) on skin or undergarments. Treatment of pubic lice is outlined in the. Initial treatment is typically with topical pediculicides. Oralivermectinis sometimes used for patients with pubic lice infestation that is refractory to topical therapies. Treatment of eyelid and eyelash infestation is often difficult and involves use of petrolatum,physostigmineointment, oralivermectin, or physical removal of lice with forceps. Sex partners should also be treated. 