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Head and Body Lice in the Elderly

A lice infestation is often thought to be a problem for school-going children when ‘nits and lice’ affects an entire class of students. But lice can also infest adults. The elderly are also a high risk group particularly those living in nursing homes and other institutions. There are three different types of lice, each of which have a predilection for different parts of the body. In the elderly, it is mainly head lice and body lice that are a problem.

What are human lice?

Lice (singular ~ louse) are tiny insects that can infest the human body and feed on blood. Although lice affects many different species of animals, the type of lice that affects people are specific for humans. Lice do not infect the human body but rather causes an infestation. The most common type is a head lice infestation caused by Pediculus humanus capitis. These lice cling to the shafts of the hair until ready to feed when it then crawls down to the scalp for a blood meal. It lays eggs (nits) at the base of the strands of hair.

Body lice infestation is caused by Pediculus humanus corporis. These lice live and lay eggs in the seams of clothing and are only found on the body when feeding. Pubic lice infestation is caused by Phthiriasis pubis, commonly referred to as crabs. It is more often transmitted through sexual contact and is less frequently seen among the elderly. Irrespective of the type of lice, an infestation can be treated and eradicated completely.

Symptoms of Lice Infestation

The symptoms of head and body lice infestation are largely the same but worth considering separately due to the difference in location.

Head lice

  • Itchy scalp that is typically worse at night when the lice feed.
  • Tickling sensation on the scalp when the lice are walking.
  • Red rash and tiny sores on the scalp.
  • White to cream-colored specks visible on at the base of the hair strand.
  • Insects may be seen crawling on the hair of the scalp.

Body lice

  • Severe itching of the skin particularly in the hip, groin and upper thigh region.
  • Scratch marks on the skin.
  • Discolored patches of the skin which are usually rough to the touch.
  • Open sores and healing wounds on the skin.

Causes and Spread of Lice

A lice infestation is known as pediculosis, or more specifically pediculosis corporis for the body and pediculosis capitis for the head. There are three stages in the life cycle of lice – egg (nits), nymph (larvae) and the adult louse.

Infestation with head or body lice is not related to poor personal hygiene as it is often thought. Rather it arises when a person who does have an infestation comes in close contact with others. The lice may then settle in the hair or clothing and start feeding on a person. However, thorough hygiene on a daily basis can detract the lice from living on the head and body.

Lice infestation can affect any person but when seen in the elderly, it is more likely to occur among patients living in nursing homes and other institutions. It can also happen among the elderly living within their own homes, particularly if they have close contact with children who may have a lice infestation. Although good personal hygiene can detract the lice from settling in at the outset, once an infestation sets in frequent bathing and thorough washing of the clothes may not be sufficient to eradicate the lice.

Treatment of Head and Body Lice

Treating head and body lice involves multiple approaches. The symptoms of a lice infestation has to be treated while the lice are being eradicated. At the same time various lifestyle measures are required to remove the lice from the environment and prevent the infestation from returning. Sometimes treatment extends to other close contacts.

  • Antihistamines may be taken to ease the itching and calamine lotion can be applied to the affected area for the same reason.
  • Shampoos containing pyrethrin and permethrin or stronger formulas containing benzyl alcohol or lindane may be used for head lice.
  • Prescription drugs like malathion of ivermectin for more resistant cases are administered orally.

For head lice, it may be advisable to remove the hair for a short period of time if possible or at least till the lice are eradicated. However, hair removal is not necessary unless other treatment measures are not effective. With body lice the focus should be on thoroughly washing clothing with hot water, through drying preferably in direct sunlight or in a spin drier on a hot dry cycle. Iron all clothing. Thorough washing of all combs and brushes in very hot water for at least 5 minutes is also advisable for head lice infestation.


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