Acrobatic” Lice
A 65-year-old man presented to the dermatology clinic with a 6-week history of severe itching in the inguinal area. Examination did not reveal any cutaneous lesions, and the symptoms were subsequently investigated by means of dermoscopy. Dermoscopy revealed a nit firmly attached to the pubic hair, as well as a moving, crab-shaped parasite (see video). No other hair-bearing areas were affected. Pubic pediculosis (“pubic lice”) caused by the organism Phthirus pubis was diagnosed. Pubic pediculosis is usually sexually transmitted but can occur after contact with fomites such as clothing, bedding, and towels used by an infected person. The condition most commonly affects teenagers and young adults. This patient reported that he had had no recent sexual contact, and no other sexually transmitted infections were identified on screening. Treatment included a regimen of oral ivermectin. Two weeks after the treatment, the itching had resolved, and no lice were seen on follow-up examination at 4 weeks.
