Pediculosis capitis is lice infestation of the scalp hair that mostly occurs in children aged 3 to 12 years. Intense scalp pruritus is the most common complaint. Pruritus may occur 2-6 weeks after the initial infestation which reflects a delayed immunologic response to the lice or excreta. Excoriation, erythema, and pyoderma on the posterior scalp and neck are typical findings. Cicatricial alopecia is a possible but rare complication. Definitive diagnosis is made through the identification of nits and / or adult lice on the scalp hair. A 6-year-old girl came with a chief complaint of pruritus on the head one week before presentation followed by pustules and nodules. Erythematous papules and plaques, crusting, excoriation, and alopecia were found in the occipital and temporal regions. In the temporal hair shaft, light brown grains which were difficult to remove were found. Microscopic examination showed nits in the hair shaft and adult lice. Dermoscopic examination of the alopecic region showed white dots and the absence of hair follicle growth, suggestive of cicatricial alopecia. The patient was treated with 1% permethrin lotion along with oral and topical antibiotics, with the permethrin repeated in the following week. The patient showed a good clinical response and no lice nor nits were found in the following appointment.
Key words: cicatricial alopecia, pediculosis capitis, 1% permethrin
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