Clinical Pearl of the Month – Pediculosis

Gerard Kiernan, MD, FAAFP, FHMClinical Pearl of the Month, Medical News

Clinical pearls of the month

Test your clinical knowledge with this clinical pearl of the month review question.

Review Question

A 5-year-old girl has been frequently scratching her scalp and has been complaining of severe pruritus. She is otherwise healthy, has had no major medical problems, and has no allergies.

She was noted to have lice by her kindergarten teacher during the school day.

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 shafts 3-4 mm from the scalp (see Figure).

Med-Challenger pearls review questions

Question

How should this child’s pediculosis (head lice) be managed?

Answer Options:

Treat with topical pyrethrin and exclude from school until completing a second application three days after the first.

Treat with 1% permethrin topically, comb hair for nits, return to school, and re-treat in a week.

Treat with topical lindane 1% and recommend a school nurse perform screening for other cases.

Apply topical malathion, blow-dry after application, and return to school the following day.

Answer Explanation & References:

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About the Author:

Gerard Kiernan, MD, FAAFP, FHM is a Dartmouth-Hitchcock Clinic hospitalist in Keene, NH. He attended the University of Rochester School of Medicine and Dentistry, followed by a Family Medicine residency at the University of Wisconsin, Madison, where he was a chief resident. Dr. Kiernan is a Lean Six Sigma Greenbelt and has led hospital medicine quality improvement efforts. He is a fellow of both the American Academy of Family Physicians and the Society of Hospital Medicine. He has achieved the Recognition of Focused Practice in Hospital Medicine offered through the AAFP and ABIM via their joint examination pathway.