Schwartz RA. Bauer E, Clin Dermatol. First-line treatment for scabies is permethrin 5% cream. 2012;367(18):1687–1693. 2004;69(2):341–348. Handbook of Non Drug Intervention (HANDI) Project Team. 25. Anderson KL, Tiplica GS. Clark JM, 4th ed. Pediculosis and scabies are caused by ectoparasites. Council on School Health and Committee on Infectious Diseases, American Academy of Pediatrics. 9. Lice, nits, and school policy. 15. Patients should be told that they may continue to itch for up to two weeks, even after appropriate and effective treatment. Pediculosis and scabies are caused by ectoparasites. Check the clothes you are wearing especially near the seams for louse eggs if you suspect you have an infestation. Lice are found all over the world, wherever people gather in close proximity, such as in schools. Early identification helps patients dodge continual symptoms in both lice and scabies. 18. Body lice infestation should be suspected in patients with pruritus who live in crowded conditions or have poor hygiene. Lice are found all over the world, wherever people gather in close proximity, such as in schools. Wolf R. Chosidow O, The easiest way to tell whether its scabies or body lice is to take a look at your body and your clothing 1. Am Fam Physician. Pubic lice produce multiple eggs daily while scabies spread in a similar fashion. *—Estimated retail price based on information obtained at http://www.goodrx.com (accessed October 22, 2018) and Walgreens. Most are found only on specific types of animal, and, in some cases, only to a particular part of the body. Both of these pestering species have the ability to cause moderate to severe symptoms, though both get treated with known remedies. The sources cited below consist of evidence from peer-reviewed journals, prominent medical organizations, academic associations, and government data. Signs of infection are the scabies zigzag pattern that hides the burrowing of the mite under the skin. Orion E, 30. Meinking TL, Drugs for head lice [published correction appears in JAMA. Pediatrics. The eggs hatch and mature into adults in 20 days.1 Viable eggs may be difficult to see but can be found attached to the base of hairs. You should always know how to prevent or treat this kinds of conditions. Scabies is contagious and can spread quickly in areas where people are in close physical contact. 12. The mites that cause scabies and all forms of the louse species cause irritation which gets associated with itching. Berdjane Z, Pubic lice (often called "crabs") and scabies (itch mites) are tiny insects that live on the skin. Silverston P. 2017;11(11):e0005920. Counseling regarding appropriate diagnosis and correct use of effective therapies is key to reducing the burden of lice and scabies. 4982, Salt Lake City, UT 84112 (e-mail: Devore CD, Pediculosis and scabies. They afflict an estimated 6 million to 12 million children in the United States each year. Villar ME, Lice, nits, and school policy. Nonovicidal agents (permethrin, pyrethrins, benzyl alcohol, dimethicone, oral ivermectin, and isopropyl myristate) typically require a repeat application for complete eradication. Head lice. Clinical inquiries. Oral ivermectin for the treatment of head lice infestation. Anyone that you've had close contact with or who has shared your bed linens, clothes, or towels should be treated, even if they don't have an itch or rash. CDC. Insecticide resistance in head lice: clinical, parasitological and genetic aspects. Humans contract all three of the aforementioned louse species in different ways, and each live distinct lifestyles with a range of breeding patterns. Having a pubic lice and scabies is never a good thing. Evaluation of a skin scraping is the diagnostic standard for detecting mites.32 A skin scraping suspended in oil allows for microscopic identification of mites, eggs, and fecal pellets; however, dermoscopy has fewer false negatives and may be preferable.26,32, A recent study showed that scabies is misdiagnosed in 45% of cases, highlighting the need for improved clinician education and diagnostic methods.32 Misdiagnosis may be due to reliance on history and physical examination findings alone rather than using microscopy, although there is evidence supporting empiric treatment if a patient presents with pruritus and he or she has lesions typical of scabies on at least two body sites or other household members also have pruritus.27,30  The differential diagnosis of scabies is presented in Table 2.5,32, Insect bites (mosquitoes, fleas, bedbugs), Permethrin 5% cream (Elimite) is the first-line treatment for scabies.29 Physicians should educate their patients about correct application of permethrin cream, reminding them that it should be applied to all areas of the body from the neck down, remain on the skin for eight to 14 hours or overnight, washed off, and reapplied in one week. Jäger G, The Canadian Paediatric Society recommends dimethicone solution and isopropyl myristate solution as second-line agents if permethrin fails after two treatments.8, A key to formulating an effective treatment regimen is recognizing the effectiveness of available treatments in destroying viable eggs because this dictates if retreatment is necessary. Permethrin 1% is recommended as first-line treatment for head lice.1,8,18, Benzyl alcohol 5% lotion (Ulesfia); prescription, Apply to dry hair, leave on for 10 minutes then rinse; repeat in seven days, 75% to 76% of patients are lice free at 14 days11, Can be costly for long hair (dosing is based on hair length) Must be used in conjunction with a lice comb (also called nit comb) Approved for persons six months and older, may be used in pregnant and lactating women, Dimethicone solution (Nix Ultra, Lice MD); OTC, Spray all over dry hair, and massage until wet; let it sit for 30 minutes, then comb into hair; leave on overnight; wash out, and use a lice comb; repeat in eight to 10 days, 70% to 96% of patients are lice free at 14 days (study of dimethicone 100%)12,13, May cause eye irritation Should not be used in children younger than two years, Apply to dry hair and scalp, leave on for 10 minutes then rinse with warm water; repeat in eight to 10 days, 54% to 82% of patients are lice free at 14 to 21 days12, May cause local and eye irritation Not recommended for children younger than four years, Ivermectin 0.5% lotion (Sklice); prescription, Not directly, but lice hatched from treated eggs die within 48 hours, Apply to dry hair and scalp, leave on for 10 minutes then rinse; one application is sufficient, 74% of patients are lice free at 15 days14, Rare adverse effects include skin and eye irritation, erythema, burning, dryness, Ivermectin, oral (Stromectol); prescription‡, 200 mcg per kg, two doses seven to 10 days apart8, 92% to 97% of patients are lice free at 14 to 15 days after two doses15, $5 ($8) for one 3-mg tablet (dosing varies based on weight), Do not use in children weighing less than 33 lb (15 kg) or in pregnant women, Malathion 0.5% lotion (Ovide); prescription, Apply to dry hair until hair and scalp are wet, allow to dry naturally, shampoo eight to 12 hours later, rinse and use a lice comb; repeat after seven to nine days only if live lice are still present, 80% of patients are lice free at 14 days16, Flammable; do not use with a hair dryer or near cigarettes or an open flame, Apply to damp hair, leave on for 10 minutes then rinse; repeat in seven days, 50% to 97% of patients are lice free at 14 days1,8,17, Pyrethrins 0.3%/piperonyl butoxide 4% shampoo or mousse (Rid); OTC, 62% to 94% of patients are lice free (unclear time frame)1, Piperonyl butoxide is thought to prolong the activity of pyrethrins Avoid in patients with chrysanthemum allergy, Spinosad 0.9% suspension (Natroba); prescription, Apply to dry hair, leave on for 10 minutes then rinse; repeat in seven days only if live lice are present, 68% to 87% of patients are lice free at 14 days16, May be used without a lice comb, although use of a lice comb improves results Safe for use in children four years and older Do not use in infants younger than six months because it contains benzyl alcohol.