This week's free board review question...
A 5-year-old girl has been scratching her scalp and complaining of severe itching. She is otherwise healthy, has had no major medical problems, and has no allergies. She is currently an only child, but her mother is pregnant. The girl just started kindergarten 6 weeks ago. The child's mother also has had an itchy scalp for the past several days, and the family dog seems to be scratching a lot.
Examination of the child reveals a healthy-appearing 5-year-old girl. You note mild excoriations behind both ears and at the base of the neck. Examination of the child's hair near the scalp reveals nits on the hair shaft-4 mm from the scalp (see Figure). The same is true for the child’s mother.
Which of the following treatment options is the most appropriate in this scenario?
Lindane is the preferred treatment for the pregnant mother.
The dog should be shampooed with malathion lotion and then closely shaved.
Initial treatment should include ivermectin due to increasing resistance.
The child should be treated with 1% permethrin, which can be repeated in 7-10 days.
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