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AAP Grand Rounds 4:42-43 (2000)
© 2000 American Academy of Pediatrics

DERMATOLOGY

Overdiagnosis and Mismanagement of Pediculosis

Source: (1) Pollack RJ, Kiszewski AE, Spielman A. Overdiagnosis and consequent mismanagement of head louse infestations in North America. Pediatr Infect Dis J. 2000;19:689–694. (2) Roberts RJ, Casey D, Morgan DA, et al. Comparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controlled trial. Lancet. 2000; 356:540–544.

The first 20% of the full text of this article appears below.

To determine the frequency of misdiagnosis of head lice infestation and consequent unnecessary treatment and exclusion from school, Pollack et al developed a free referral service to which specimens believed to represent lice or nits could be submitted for diagnostic confirmation. Samples were submitted with a questionnaire that elicited information about the person believed to be infested, the diagnostician, pediculicide treatment in the preceding 4 weeks and whether the school the child attended had a no-nit policy. Specimens were examined at 20X using a dissecting microscope; subjects were considered to be actively infested if the sample included a louse or an egg containing a viable embryo, while an empty egg or egg containing the remnants of a dead embryo was considered evidence of a past infestation.

A total of 614 submissions were obtained from 541 subjects. Samples were submitted primarily from the United States (42 states) but also from Canada (13), Japan (10), United Kingdom (2), Australia (1) and Singapore (1). Of the 450 specimens for whom age was reported, 77% were less than age 21 years, and 81% of these samples came from female subjects. Lice or eggs were present in 59.3% of specimens (53.3% of these were considered viable); 5.4% contained other arthropods (mites, bedbugs, etc.), 35.2% debris . . . [Full Text of this Article]

Daniel P. Krowchuk, MD, FAAP
Pediatrics and Dermatology, Wake Forest University, Winston-Salem, NC