SA EDL (Essential Drug List)
EDL: 2020-4_Version 1.0_7 November 2024
5.7 PARASITIC INFESTATIONS OF THE SKIN
5.7.1 LICE (PEDICULOSIS)
DESCRIPTION
An infestation of the body with parasitic lice.
Clinical features include:
» itching
» bite marks
» presence of secondary eczema and secondary infection
CAUTION
Do not use commercial insect sprays as they are toxic.
Lotions used for the treatment of lice are toxic when swallowed.
Treat secondary infection with antibiotics. See Section 5.4.2: Impetigo.
5.7.1.1 HEAD LICE
B85.0
DESCRIPTION
Head lice are common in children. The eggs (nits) appear as fixed white specks on the hair.
GENERAL MEASURES
» Use a fine comb to comb out the nits after washing hair.
» Shaving of the head may expedite treatment, where socially acceptable.
» Prevent spread by treating other contacts.
» Remove nits from eyelashes by applications of white soft paraffin.
MEDICINE TREATMENT
Permethrin 5%, topical
2020 5.14 CHAPTER 5 SKIN CONDITIONS
o Apply permethrin 5% lotion to towel-dried or dry hair. Comb into hair repeatedly
with a normal comb until scalp is covered completely.
o Remove lice and nymphs with fine lice comb, by dividing scalp into sections and
combing away from scalp.
o Rinse lice comb in a white bowl filled with hot water between hair strokes to identify
removed lice, or detach on white tissue paper. Paralysed and dead lice will present
as dark spots (like ground pepper).
o Take note of the physical size of removed lice and nymphs, as the size should get
smaller with consecutive treatments.
o Keep on combing with fine lice comb, rinsing or wiping comb frequently.
o Permethrin 5% lotion is safe and can be left in the hair for up to one hour.
o After combing, rinse hair with lukewarm water and wash permethrin 5% lotion out
with normal shampoo (more than one foaming might be needed).
o Repeat this procedure every 5 days for 3 weeks.
o Thereafter, carry out frequent inspections to detect new infestations early.
Note:
o Do not apply to broken skin or sores.
o Avoid contact with eyes.
LoE:III83
5.7.1.2 BODY LICE
B85.1/B85.4
Body lice live in the seams of clothing and only come to the skin to feed.
Note: Body lice may carry typhus fever.
GENERAL MEASURES
Regularly wash bed linen and underclothes in hot water and expose to sunlight.
MEDICINE TREATMENT
Adults and adolescent children
Benzyl benzoate 25% lotion, undiluted, applied over the whole body.
o Leave on overnight and wash off the next day.
o Repeat once a week for up to 3 weeks.
Note:
o Do not apply to neck and face.
o Avoid contact with eyes and broken skin or sores.
o The lotion is toxic if swallowed.
o Do not continue if a rash or swelling develops.
o Itching may continue for 2–3 weeks after treatment.
LoE:II84
5.7.1.3 PUBIC LICE
B85.3/B85.4
DESCRIPTION
Pubic lice are acquired as STIs and nits are found on pubic hair and eyelashes.
2020 5.15CHAPTER 5 SKIN CONDITIONS
GENERAL MEASURES
Prevent spread by treating other contacts.
MEDICINE TREATMENT
Benzyl benzoate 25%
o Apply to affected area.
o Leave on for 24 hours, then wash thoroughly.
o Repeat in 7 days.
Pediculosis of the eyelashes or eyebrows
Yellow petroleum jelly (Note: Do not use white petroleum jelly near the eyes).
o Apply to the eyelid margins (cover the eyelashes) daily for 10 days to smother lice
and nits.
o Do not apply to eyes.
REFERRAL
Lice infestation of eyelashes in children to exclude suspected sexual abuse.
LoE:III
5.7.2 SCABIES
B86
DESCRIPTION
An infestation with the parasite Sarcoptes scabei.
Commonly occurs in the skin folds. The infestation spreads easily, usually affecting more
than one person in the household.
Clinical features include:
» intense itching, which is more severe at night
» small burrows between fingers, toes, elbow areas and buttocks where the parasite
has burrowed under the skin
» secondary infection which may occur due to scratching with dirty nails
» in small babies, there are often vesicles and pustules on the palms and soles and
sometimes on the scalp
GENERAL MEASURES
All close contacts must be treated simultaneously even if they are not itchy see
medicinal treatment below.
» Cut finger nails and keep them clean.
» Wash all linen and underclothes in hot water.
» Expose all bedding to direct sunlight.
» Put on clean, washed clothes after medicine treatment.
MEDICINE TREATMENT
Adults and children > 6 years of age
Benzyl benzoate 25% lotion applied undiluted to the whole body from neck to feet and
rub in well.
o Allow the lotion to remain on the body for 24 hours, then wash off using soap and
water.
2020 5.16 CHAPTER 5 SKIN CONDITIONS
LoE:I85
o For severe infestation treatment may be repeated after 24 hours or once within 5
days.
o All infected persons living in the household, or likely to contract the infection,
should be treated at the same time.
If benzyl benzoate is unsuccessful:
Permethrin 5%, topical, apply lotion undiluted to the whole body from neck to feet.
o Leave on overnight (8–12 hours) and wash off the following
morning.
Children < 6 years of age
Permethrin 5%, topical, apply lotion undiluted to the whole body from neck to feet
o Leave on overnight (8–12 hours) and wash off the following
morning.
Note:
» Benzyl benzoate and permethrin are toxic if swallowed.
» Avoid contact with eyes and broken skin or sores.
» Do not continue if rash or swelling develops.
» Itching may continue for 2–3 weeks after treatment.
Treatment may need to be repeated after one week.
Treat secondary infection with antibiotics. See Section 5.4.2: Impetigo.