Entodermoscopy: dermoscopy for the diagnosis of pediculosis

Criado, Paulo Ricardo

doi:10.1590/S0365-05962011000200027

Abstracts

We report a clinical case in which contactless dermoscopy was used as an aid to the diagnosis of pediculosis and clinical evaluation of the effectiveness of treatment of this condition.

Dermoscopy; Lice infestations; Pruritus

Relata-se um caso clínico no qual a dermatoscopia de epiluminescência sem contato foi empregada como método auxiliar para o diagnóstico e a avaliação clínica da eficácia do tratamento da pediculose do couro cabeludo.

IMAGES IN DERMATOLOGY

PhD (Dermatology), Faculty of Medicine, University of São Paulo - Physician in the Dermatology Division, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil

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ABSTRACT

We report a clinical case in which contactless dermoscopy was used as an aid to the diagnosis of pediculosis and clinical evaluation of the effectiveness of treatment of this condition.

Keywords: Dermoscopy; Lice infestations; Pruritus

A six-year-old infant was brought by his parents to our clinic, where he was seen for pruritus of the scalp of one month's duration. Physical examination with the aid of contactless dermoscopy (DE) revealed the presence of an empty nit case attached to a hair, which was removed so that it could be examined more closely (Figure 1A). The parents were informed of the diagnosis and given advice on the appropriate treatment, namely, treatment with deltamethrin shampoo in two three-day treatment cycles separated by a one-week interval and manual removal of the nits.

After one month the child returned to the clinic and presented with persistent pruritus of the scalp. Physical examination failed to reveal the presence of nits. However, using DE we were able to observe live lice (Pediculus humanus var. capitis) in the hair (Figures 1B and 1C); more detailed pictures of the lice on a white surface are shown in Figures 1D and 1E.

Although dermoscopy was initially developed for the diagnosis of pigmented lesions, ¹it has been used as an aid to diagnosis in squamous diseases, depigmenting diseases, pseudofolliculitis barbae, infections and infestations. ¹Dermoscopic patterns have already been described for viral warts, molluscum contagiosum and tinea nigra among other conditions. ¹The term"entodermoscopy" was coined to refer to the use of DE as an aid in the diagnosis and follow-up of treatment of infestations such as scabies, pediculosis, tungiasis, cutaneous larva migrans and tick infestations, as well as reactions to the spicules of spiders. ^1,2

Head lice infestation can very often be detected with the 4 eye, and examination with a magnifying glass is usually sufficient. However, as in our patient, the number of lice and/or nits may make detection by traditional methods difficult. This problem can be overcome by using DE.

REFERENCES

1. Zalaudek I, Giacomel J, Cabo H, Di Stefani A, Ferrara G, Hofmann-Wellenhof R, et al. Entodermoscopy: a new tool for diagnosing skin infections and infestations. Dermatology. 2008;216:14-23.
2. Tschandl P, Argenziano G, Bakos R, Gourhant JY, Hofmann-Wellenhof R, Kittler H, et al. Dermoscopy and entomology (entomodermoscopy). J Dtsch Dermatol Ges. 2009;7:589-96.