Epidemiology is difficult to elucidate as the infection is likely under-recognized and can be treated without presentation to a health care provider. However, this condition is more common in sexually active individuals. Lice live on terminal hair, typically in the pubic and perianal regions, although infestations may also be noted in the eyelashes (pediculosis palpebrarum), eyebrows, and other facial hair, as well as chest and axillary hair. Scalp infestation may also be seen in tightly curled hair. The lice are not adapted for crawling.
The incubation time is less than one week from contact, although it has been found to be longer in some cases. The eggs (nits) are cemented to hair shafts with chitin and are difficult to remove. Lice hatch in approximately 6-10 days. The lifespan of the louse is less than 1 month. The lice are not able to survive without feeding within 24 hours.
Although the bites of the lice are thought to be painless, the majority of those infected will present with extreme pruritus; one study suggests up to 86% will complain of pruritus. This is thought to be secondary to a reaction to the saliva and/or the anticoagulant injected into the skin by the louse during feeding.
B85.3 – Phthiriasis
71011005 – Pediculosis pubis
Pediculosis capitis and pediculosis corporis can be distinguished based on the prevailing location of the lice (pediculosis capitis is predominantly on scalp hair, while pediculosis corporis is predominantly identified on clothing) and the physical appearance of the lice (pediculosis capitis, corporis lice are more slender).
Other considerations include:
- Other arthropod bites / stings
- Neurotic excoriations
- Delusions of parasitosis
- Irritant contact dermatitis
- Other causes of anogenital itch, including tinea cruris, allergic contact dermatitis, and candidiasis
- Peripilar hair casts – usually scalp hair affected
- Pityriasis amiantacea – usually scalp hair affected
- Trichomycosis axillaris – axillary and pubic hair may be affected
- White piedra – pubic, axillary, and facial hair may be affected
- Black piedra – usually scalp hair affected