Pandemic skin care plus body lice management

04/09/20 • 18 min

Body lice present an important public health concern due to the potential spread of infectious diseases. Dr. Vincent DeLeo talks with Dr. Dirk Elston about how to identify and manage human body lice infestations.

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We also bring you the latest in dermatology news and research:

1. Skin manifestations are emerging in the coronavirus pandemic 2. NCCN panel: Defer nonurgent skin cancer care during pandemic 3. iPLEDGE allows at-home pregnancy tests during pandemic

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Key takeaways from this episode:

Human body lice are similar in appearance to head lice but can be differentiated based on the location of the infestation: “Body lice tend to lay their eggs in seams of clothing and on the fibers of hair in clothing rather than on the hairs on the head,” Dr. Elston notes.
Body lice are transmitted through prolonged person-to-person contact associated with mass crowding, refugees, poverty, and homelessness.
Patients with body lice typically present with generalized pruritus, maculated ceruleae, and hemosiderin deposits in the skin where the lice have fed, as well as lice and nits in the clothing.
Body lice can be treated entirely with treatment of the clothing. “Pharmacologic intervention in the case of body lice is more for disease that the body louse may have spread,” Dr. Elston explains.
Clinical signs and symptoms of body lice infestation include sepsis or more serious infection, typhus, eschar associated with other rickettsial-type diseases, endocarditis, cat scratch fever, acral splinter hemorrhages, and Osler-type nodes. “Most of these patients won’t present to us in clinic but more likely to [the] emergency department,” says Dr. Elston.
Unlike body lice, head lice can be treated by shaving the head or other topical treatments. Combing through the hair has shown low efficacy rates. “Head lice are widespread. They know no economic or social boundaries. ... Fortunately, they are not known to be significant vectors of disease, but they are certainly a nuisance and something that carries a significant social stigma,” advises Dr. Elston.
Transmission of lice is highly preventable. “[The] simple separation of clothing is the greatest intervention that we can do to prevent spread among schoolchildren, and it’s really a very simple and common-sense thing to do,” Dr. Elston says.
If a patient has very coarse curly hair, pubic lice are more likely to infest the scalp than head lice. Pubic lice also are common in body hair, particularly in males, and are not just restricted to the pubic region.

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Hosts: Nick Andrews, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)

Guest: Dirk M. Elston, MD (Medical University of South Carolina, Charleston)

Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Elston reports no conflicts of interest.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

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We also bring you the latest in dermatology news and research:

1. Skin manifestations are emerging in the coronavirus pandemic 2. NCCN panel: Defer nonurgent skin cancer care during pandemic 3. iPLEDGE allows at-home pregnancy tests during pandemic

* *

Key takeaways from this episode:

Human body lice are similar in appearance to head lice but can be differentiated based on the location of the infestation: “Body lice tend to lay their eggs in seams of clothing and on the fibers of hair in clothing rather than on the hairs on the head,” Dr. Elston notes.
Body lice are transmitted through prolonged person-to-person contact associated with mass crowding, refugees, poverty, and homelessness.
Patients with body lice typically present with generalized pruritus, maculated ceruleae, and hemosiderin deposits in the skin where the lice have fed, as well as lice and nits in the clothing.
Body lice can be treated entirely with treatment of the clothing. “Pharmacologic intervention in the case of body lice is more for disease that the body louse may have spread,” Dr. Elston explains.
Clinical signs and symptoms of body lice infestation include sepsis or more serious infection, typhus, eschar associated with other rickettsial-type diseases, endocarditis, cat scratch fever, acral splinter hemorrhages, and Osler-type nodes. “Most of these patients won’t present to us in clinic but more likely to [the] emergency department,” says Dr. Elston.
Unlike body lice, head lice can be treated by shaving the head or other topical treatments. Combing through the hair has shown low efficacy rates. “Head lice are widespread. They know no economic or social boundaries. ... Fortunately, they are not known to be significant vectors of disease, but they are certainly a nuisance and something that carries a significant social stigma,” advises Dr. Elston.
Transmission of lice is highly preventable. “[The] simple separation of clothing is the greatest intervention that we can do to prevent spread among schoolchildren, and it’s really a very simple and common-sense thing to do,” Dr. Elston says.
If a patient has very coarse curly hair, pubic lice are more likely to infest the scalp than head lice. Pubic lice also are common in body hair, particularly in males, and are not just restricted to the pubic region.

* *

Hosts: Nick Andrews, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)

Guest: Dirk M. Elston, MD (Medical University of South Carolina, Charleston)

Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Elston reports no conflicts of interest.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Previous Episode

Bonus: COVID-19 critical-care lessons from Seattle

As the nation’s health care system braces for COVID-19 cases, physicians who’ve faced the pandemic first have critical lessons for everyone.

In this bonus episode of Dermatology Weekly, two Seattle-area critical care leaders explain how their medical centers are preparing for and responding to their region’s early outbreaks. And they share some creative approaches that are uniting Seattle’s critical care departments.

Next Episode

COVID-19: What Now? And are nail biopsy videos on YouTube reliable?

Patients, medical students, residents, and even attendings often seek reliable information about nail biopsy procedures on the Internet. Dr. Vincent DeLeo talks with Dr. Shari Lipner about the quality and credibility of nail biopsy videos on YouTube. “There is a need for reliable information for dermatologists and students and residents to learn more about this, and I do think we have the resources to put together a good instructional video,” Dr. Lipner says.

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We also bring you the latest in dermatology news and research:

1. COVID-19: What Now?

2. Presymptomatic or asymptomatic? ID experts on shifting terminology

3. Cardiology groups push back on hydroxychloroquine, azithromycin for COVID-19

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Key takeaways from this episode:

Not all nail biopsy videos on YouTube are produced by reliable sources.
In a recent analysis, the top 10 most relevant nail biopsy videos on YouTube were associated with a number of shortcomings.
Medical students, residents, and dermatologists are advised to seek other more reliable opportunities to learn about nail biopsy procedures: “Probably the best would be to learn in person how to do a biopsy from a nail specialist or a Mohs surgeon,” Dr. Lipner suggests. She also recommends didactic sessions in which physicians can practice biopsy procedures on cadaver nails.
The American Academy of Dermatology offers a hands-on nail surgery course at its annual meetings, where dermatologists can work on cadaver nails under the direction of at least 10 nail specialists.
The most reliable resource for patients on nail biopsies is education from a board-certified dermatologist. There is a need for more patient education materials that explain the procedure in detail.

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Hosts: Nick Andrews, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)

Guest: Shari R. Lipner, MD, PhD (Weill Cornell Medicine, New York)

Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Lipner reports no conflict of interest.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm