A 55 year old patient comes in with itching to her scalp – so bad that it is setting off her migraine headaches.
She’s been to her family physician twice already and was first prescribed antibiotics for a scalp infection, then was prescribed steroid lotion for the inflammation. She was feeling worse.
When I examined her, she had several bite marks to the base of her neck and over the ears. You could also see the dried hydrocortisone cream in her hair. Then I saw movement and I pulled out the insect pictured.
What is the diagnosis and what is the treatment?
UPDATE AUGUST 25, 2010
OK, you all are too smart. Head lice, it is.
I had never seen a live head louse before and had to look it up on the internet. I knew it wasn’t a bedbug and suspected it was a louse because of the couple of lice nits on the patient’s hair.
Treatment recommendations vary.
Shaving the head is a radical but curative approach.
The American Academy of Pediatrics recommends copious amounts of amoxicillin, then Augmentin if that doesn’t work just came out with an excellent clinical report on head lice last month (.pdf format).
Pediculicides (chemicals) such as “Quell,” “Nix” and “Rid” are still the mainstay of treatment according to this paper. Benzyl Alcohol also works well. While oils have been used to remove lice, the report states that their effect is not reproducible. Occlusive agents such as petroleum shampoos, mayonnaise, and herbal oils “have not been evaluated for effectiveness in randomized, controlled trials.”
A dessicator can be used to blow hot air on the lice to kill them – with good results. Using a blow dryer to try this at home will cause live lice to become airborne and spread all over your house. Don’t do it.