Pedikulosis

Pediculosis, the infestation of humans by lice, has been a human affliction since antiquity.
Three species of lice infest humans: (a) Pediculus humanus capitis, the head louse,
(b) Pediculus humanus humanus, the body or clothing louse, and (c) Phthirus pubis, the
pubic, or crab, louse. Patients present with pruritus secondary to a delayed hypersensitivity
reaction. After the initial exposure, it may take 2 to 6 weeks for the pruritus to occur.
Subsequent exposure results in symptoms within 1 to 2 days of exposure.33

PEDICULOSIS CAPITIS (HEAD LICE)

AT-A-GLANCE

 Infestation occurs worldwide affecting hairs of the scalp most commonly in children
between the ages of 3 and 12 years.
 Presence of 0.8-mm eggs (nits) firmly attached to scalp hairs is most common sign of
infestation.
 Spread by close physical contact and sharing of headgear, combs, brushes, and
pillows.
 Resistance to traditional nonprescription preparations is growing;
topical malathionand ivermectin should be considered in resistant cases.

EPIDEMIOLOGY
Head lice infestations occur worldwide and are most common in children between the ages
of 3 and 12 years.34 Based on pediculicide sales in the United States, an estimated 10 to 12
million children are infected each year. Head lice affect all levels of society, and all ethnic
groups; however, the incidence is low among African Americans in the United States,
possibly as a consequence of an anatomic inability of female lice in America to deposit eggs
on coarse curly hair.35 A recent study by Koch and associates showed an increase in trend in
the number of prescriptions suggesting either an increase in the number of infestations or
increased failure rates of nonprescription home regimens.36

Transmission occurs primarily by means of direct head-to-head contact and less commonly
by indirect (fomite) transmission through combs, brushes, blow-dryers, hair accessories,
upholstery, pillows, bedding, helmets, or other headgear. 37-42 Lice can be dislodged by air
movement, blow-dryers, combs, and towels, and passively transferred to fabric, facilitating
new infestations.30-32,34,35

ETIOLOGY AND PATHOGENESIS

Head lice are blood-sucking, wingless, highly host-specific insects belonging to the order
Anoplura. They are almost 2 mm long with 3 pairs of claw-like legs that are well adapted for
grasping hair. Their entire life cycle is on the scalp (Fig. 178-6). More than 95% of infested
individuals have fewer than 100 adult lice in their scalps. The female louse lays 5 to 10 eggs
per day during her 30-day life span. After 10 days, the eggs hatch producing larvae, which
are referred to as nymphs or “instars.” Instars look like miniature adult louse and go through
3 stages of development that take 14 days for full maturation. The eggs are laid
approximately 1 cm from the scalp surface, firmly attached to individual hairs with a
proteinaceous glue secreted by the female louse and that closely resembles the amino acid
composition of the human hair shaft itself.43,44

FIGURE 178-6
Head louse life cycle. During egg laying, the female louse secretes a proteinaceous cement
that flows from the genital opening to adhere the egg tightly onto the hair shaft (1 and 2).
The hatch-ready louse uses its mouthparts to cut a circular hole in the operculum and sucks
in air, which is expelled from its posterior, causing it to be quickly ejected from the egg,
typically 5 to 10 days after the egg was first laid (3 and 4). The emerged instar requires a
blood meal soon after hatching, and completes 3 molts, taking a blood meal between each,
before developing into an adult 9 to 12 days after hatching (4, 5, and 6). (Adapted from
Figure 1 in Koch E, Clark JM, Cohen B, et al. Management of head louse infestations in the
United States—a literature review. Pediatr Dermatol. 2016;33:466-472, with permission.
Copyright © 2016, John Wiley and Sons.)

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Lice typically survive less than 2 days away from the scalp, although under favorable
conditions of heat and humidity, survival has been reported at 4 days. Nits can survive for
10 days away from the scalp.
CLINICAL FINDINGS
Pediculosis capitis is confined to the scalp with nits (Fig. 178-7) found most readily in the
occipital and retroauricular regions. Most patients experience pruritus. The average
incubation before symptoms is 4 to 6 weeks. Some individuals remain asymptomatic despite
infestation, and can be considered “carriers.”

FIGURE 178-7
Nit sheath. Microscopic view of an egg, containing an unhatched louse, attached to a hair
shaft.

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Mite bites may produce 2-mm erythematous macules or papules, but usually an examiner
only finds excoriations, erythema, and scaling. Other findings may include a low-grade fever,
regional lymphadenopathy, and irritability.

Infestations are diagnosed by demonstrating egg capsules (nits) and live lice. Nits are readily
seen by the naked eye and are an efficient marker of past or present infestation. They can
be differentiated from dandruff, hair casts, and the like, as nits are not easily removed from
the hair shaft.45 The color of newly laid or viable eggs is tan to brown; the remains of eggs
that have hatched are clear, white, or light in color. Moreover, newly laid eggs are usually
identified within a few millimeters of the scalp and lice embryos can be seen on
dermoscopy, while hatched nits are usually further from the scalp. The presence of adult
lice confirms active infestation. However, lice are fast, avoid light, and blend in with the hair,
making them difficult to find. Finding live adult lice or immature nymphs is best achieved
with fine combing the hair with a nit comb. Wet combing, in which water and conditioner
are applied to the hair prior to using the nit comb, increases the yield by prying the adult lice
from the hair follicles.44,45

DIFFERENTIAL DIAGNOSIS
Table 178-4 outlines the differential diagnosis of head lice.

TABLE 178-4Differential Diagnosis of Head Lice

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COMPLICATIONS
Although head lice have never been identified as a source of transmission of infection,
secondary bacterial infections can occur with pediculosis capitis. In fact, head lice are
thought to be the most common cause of pyodermas of the scalp in the developed world. 46

Head lice and body lice are closely related, so it is not surprising that head lice can serve as
host for rickettsiae and have the potential of transmitting diseases.47,48 Head lice in
laboratory experiments have been readily infected with Rickettsia prowazekii.49 Bartonella
quintana, which causes trench fever, also has been isolated in head lice.50-53 Transmission of
these infections to humans by pediculosus capitis, however, has never been described and it
is highly unlikely to occur outside of experimental conditions.

TREATMENT
Standard treatment recommendations for pediculosis capitis utilize a 2-step process of
confirming active infestation with live lice and then treating the infestation with a
nonprescription or prescription pediculicidal therapy. Pediculicide choice is typically based
on local resistance patterns and access of patients to a physician for prescription
medications.54 However, with increasing resistance to pediculicides, a multimodal approach,
similar to Staphylococcus aureus therapy, is warranted to prevent widespread resistance to
currently available products.55 This is especially important when treating with prescription
pediculicides.

Physical methods to treat infestations, including shaving one’s head to avoid infestation,
dates back to the 6th century BC, when priests and wealthy Egyptians removed scalp hair
and wore wigs. The routine of head shaving for military services today was founded on the
same principle. While a buzz haircut may be a solution for boys, such an approach would be
traumatic psychologically for girls. Another method is to comb the nits out after application
of a hair moisturizer such as Cetaphil. The moisturizer is applied, left in for 2 minutes, then
all the lotion is combed out. The hair is then dried with a hair dryer. This can be done every
few days, with the best results showing cure rates of 95% if done over a 24-day
period.56However, combing out nits is difficult, tedious, time-consuming, and somewhat
painful. Although wet combing can be an adjuvant to topical insecticidal therapy, it is not, by
itself, sufficient in most situations.47

Pediculicides remain the most effective treatment for head lice. 57-64 Given (a) variable
ovicidal activity, (b) possible lack of patient compliance, (c) growing resistance to
pediculicides, and (d) the potential of fomite reinfestation, it is recommended to repeat -
treatment with all insecticidal treatments in 1 week.

Table 178-5 summarizes the array of treatments for head lice. One of the leading factors for
the increasing number of infestations is resistance of lice to topical therapies. 65-70 Since the
introduction of insecticides years ago, the louse has adapted by several genetic alterations.
The agents with the highest success rates, namely malathion and ivermectin, are
prescription products. One trial has shown oral ivermectin given twice at a 7-day interval to
be more effective than topical malathion lotion.71 However, both pediculicides are highly
effective and treatment decisions should be based on local resistance patterns and
individual patient characteristics.

TABLE 178-5Treatment of Head Lice and Crab Lice

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There are a number of anecdotal and market-driven reports with occlusive and suffocation
methods (such as with application of petrolatum, mayonnaise, dimethicone, vegetable
oil, mineral oil, hair pomade, and olive oil).72,73 However, there are no studies establishing
the safety and efficacy.36 To accurately evaluate pediculicidal activity of any compound, one
must appreciate that head lice have the ability to “resurrect” from a state of seeming death,
in which respiratory and motor function appear to have ceased. 74,75 These insects are less
dependent than mammals for continuous nervous control of respiration and circulation, and
the exact point of death is not readily defined. Indeed, the World Health Organization
recommends pediculicidal testing to be read 24 hours after application of insecticide
because doing otherwise results in overestimation of mortality rates. 52 Not following these
guidelines has led to overestimates of the efficacy of several alternative treatments with
occlusive agents and essential oils from health food stores. Such products slow the
movements of adult lice and may allow them to be more easily combed out of the scalp, but
these substances are usually not lethal to lice.

Patients should be counseled in at least some effective measures to prevent reinfestation by

fomite transmission. After treatment, treated individuals should wear clean clothing, and all
clothing, hats, pillow cases, towels, and bedding used during the previous week should be
washed in hot water and dried at high heat. Nonwashables should be dry-cleaned, ironed,
put in the clothes dryer without washing, or stored in a sealed plastic bag in a warm area for
2 weeks. Combs and brushes may be washed in very hot water (65°C [149°F]) or may be
coated with the pediculicide for 15 minutes. Floors, carpets, upholstery (in both home and
car), play areas, and furniture should be carefully vacuumed to remove any hairs with viable
eggs attached. Fumigation of living spaces is not recommended and pets do not need to be
treated because they do not harbor the human head louse. Despite treatment, nits can
remain on the hair for months. Therefore a strict “no nit” policy will only result in significant
absence from school.76 As a result, the American Academy of Pediatrics does not
recommend a “no nit” policy.

PEDICULOSIS CORPORIS (BODY LICE)

AT-A-GLANCE

 Infestations most commonly found in homeless individuals, refugees, and victims of

war and natural disasters.
 Diagnosis made by presence of nits in lining of clothing, particularly the seams.
 Infections transmitted by body lice include epidemic typhus, trench fever, and
relapsing fever.

ETIOLOGY AND PATHOGENESIS

P. humanus humanus, body lice, have a very similar morphology to head lice, except they
are 30% larger. The body louse’s life span is 20 days during which the female may lay up to
300 eggs. The lice lay their eggs in the seams of clothing, while obtaining their blood meals
from the host. The body louse can survive without a blood meal for up to 3 days.

EPIDEMIOLOGY
Pediculosis corporis requires exposure to the louse and favors an inability to wash and
change clothing. Consequently, it is most commonly found on homeless individuals,
refugees, victims of war and natural disasters, or those forced into crowded living conditions
with poor hygiene. The infestation is usually transmitted by contaminated clothing or
bedding. After exposure, the inability to wash or change clothes allows the infestation to
persist.

CLINICAL FINDINGS
Symptomatically, patients complain of pruritus. Most commonly, the only sign of body lice is
excoriations, often linear and primarily on the back, neck, shoulders, and waist.
Postinflammatory pigmentation is seen in chronic cases. Adult lice are not easily seen except
in heavy infestations. Diagnosis is made by closely examining the lining of the clothing,
particularly at the seams, for the presence of nits. The clothing also may be shaken over a
sheet of white paper, at which time the lice may be seen moving about on the paper.

DIFFERENTIAL DIAGNOSIS
Table 178-6 outlines the differential diagnosis of body lice.

TABLE 178-6Differential Diagnosis of Body Lice

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 COMPLICATIONS
Several important human diseases are transmitted by the body louse. The major diseases
include epidemic typhus (caused by a rickettsiae, R. prowazekii), murine typhus (caused
by Rickettsia typhi), trench fever (caused by B. quintana), and relapsing fever (caused by a
spirochete, Borrelia recurrentis).77-81 Lice obtain organisms, such as rickettsiae and
spirochetes, from ingestion of blood meals from infested hosts. Transmission of
microorganisms from body lice is not from the louse bite, but rather by (a) contaminated
fecal material being scratched into excoriated skin of bite sites, (b) inhalation of dry,
powdery louse feces from handling typhus-contaminated bedding or clothing, or (c) an
infected louse having its gut ruptured, allowing an infective blood meal to enter excoriations
on the skin. In addition, excoriation can lead to secondary infection with S. aureus, S.
pyogenes, and other bacteria.

TREATMENT
The most important treatment for body lice is disinfestation of all clothing and bedding.
Beds should be burned or sprayed with lice sprays, because the body louse may lay eggs on
the seams of the mattress or couch. Clothing is best treated like biohazardous waste,
bagged, and tightly sealed in specially marked, plastic, biohazard bags. The waste is handled
separately from other trash until it can be incinerated, maintaining a temperature of 65°C
(149°F) for 30 minutes. If this is not possible, clothing and bedding should be fumigated,
machine washed in hot water, and dried on high heat or dry-cleaned. Hot ironing of the
seams of upholstered furniture should also be performed and exposure to infested items
should be strictly avoided for 2 weeks. The patient should be treated from head to toe with
a topical insecticide or given oral ivermectin.

PEDICULOSIS PUBIS (CRAB LICE)

AT-A-GLANCE

 Best to call “crab lice” (rather than “pubic lice”) as infestations may involve other
hair-bearing sites such as mustache, beard, axillae, eyelashes, eyebrows, and scalp
hair.
 Transmitted by sexual or close contact, as well as via fomites (contaminated clothing,
towels, and bedding).
 Topical therapy options similar to pediculosis capitis, but oral ivermectin is the
preferred treatment for this infestation.

ETIOLOGY AND PATHOGENESIS

Pediculosis pubis is caused by infestation of the body with P. pubis. Crab lice range from 0.8
to 1.2 mm in length and have wide, short bodies resembling tiny crabs. They have a serrated
edge on their first claw, which gives them traction on flat, hairless, surfaces; thus, they can
navigate across the entire body surface. They most commonly are found in the pubic and
perianal region, but occasionally they also reside in mustache, beard, axillae, eyelashes,
eyebrows, and scalp hair. In hirsute individuals, they are also found on the short hairs of the
thighs and trunk. The louse has a life span of less than 3 weeks, during which time the
female will lay approximately 25 eggs on human hairs. The adult crab louse can survive for
36 hours off the human host, and the eggs are viable for up to 10 days.

EPIDEMIOLOGY
Crab lice can be found in all levels of society and all ethnic groups. Patients with crab lice
often have another concurrent sexually transmitted disease. Although pediculosis pubis is
considered a sexually transmitted disease, transmission has been documented to occur from
contaminated clothing, towels, and bedding.

CLINICAL FINDINGS
In the case of crab lice, all hairy parts of the body should be examined, especially the
eyelashes, eyebrows, and perianal area. Many individuals have 2 different hair-bearing sites
infested.82 These lice can be mistaken for scabs or moles, or can blend in with skin color,
making them difficult to detect. Infested patients have an average of 10 to 25 adult
organisms on their body. Nits also can be identified near the base of hairs (Fig. 178-8). The
diagnosis can be confirmed by microscopic examination of the plucked hair to identify the
nits and/or adult lice. Although rare, skin lesions named maculae caerulea, representing
hemorrhage, can be seen with pubic lice, with slate gray to bluish, irregular-shaped macules
approximately 1 cm in diameter. Pediculosis palpebrarum, or phthiriasis palpebrarum, is the
infestation of the eyelashes with crab lice.

FIGURE 178-8
Pediculosis pubis. Several lice and their dot-like nits attached to the hair shafts can be seen
in the pubic area of this patient. (Used with permission from D.A. Burns, MD.)
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DIFFERENTIAL DIAGNOSIS
Table 178-7 outlines the differential diagnosis of crab lice.

TABLE 178-7Differential Diagnosis of Crab Lice

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TREATMENT
Shaving is not curative as the louse will seek another hairy area of the body to reside. Crab
lice are treated with the same topical therapy as that for pediculosis capitis (see Table 178-
5).83 In vitro and in vivo resistance to pyrethrins have been shown.84 There is a lack of
appreciation for their tendency to inhabit rectal hair.82 Unless the physician is certain that
only one body area is involved, all hairy areas of the body should be treated because (a) it is
not uncommon to have other areas infested, and (b) lice can migrate away from a treated
areas to other hair-bearing locations. For this reason, oral ivermectin is recommended for
this entity.52 However, as ivermectin treatment relies on the insect obtaining a blood meal,
so the nits are not affected and the patient requires repeat oral ivermectin on day 8 and day
15.

Phthiriasis palpebrarum (Fig. 178-9) has traditionally been treated with petrolatum
(Vaseline), but this treatment is slow and needs to be applied at least 5 times a day for
weeks. Ivermectin is the first-line therapy for this condition.85
FIGURE 178-9
Pediculosis pubis. Eyelash infestation with Pthirus pubis. Nits can be seen attached to the
eyelashes. (Used with permission from D.A. Burns, MD.)

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Fomite precautions mirror those discussed previously for pediculosis capitis. Treatment
failure is usually a result of failure to treat all hairy areas (especially perirectally) or
reinfestation from neglecting to treat sexual contacts. Other household members are also
infested occasionally and should be carefully questioned for symptoms and/or examined.
Pedikulosis adalah infeksi kulit kepala pada manusia yang disebabkan oleh parasit Pediculus.
[1] Selain menyerang manusia, penyakit ini juga menyerang binatang,oleh karena itu
dibedakan Pediculus humanus dengan Pediculus animalis.[1] Pediculus ini merupakan
parasit obligat yang menghisap darah manusia untuk dapat mempertahankan hidup.[1]

Penyakit ini terutama menyerang anak-anak usia muda dan cepat meluas dalam lingkungan
hidup yang padat, misalnya di asrama dan panti asuhan.[1] Tambahan pula dalam kondisi
kebersihan yang tidak baik, misalnya jarang membersihkan rambut atau rambut yang relatif
susah dibersihkan (rambut yang sangat panjang pada wanita).[1] Cara penularannya
biasanya melalui perantara (benda), misalnya sisir, bantal, kasur, dan topi.[1]

Gejala yang terutama adalah gatal di daerah kulit kepala, dan terdapat bercak-bercak yang
berwarna abu-abu atau kebiruan yang disebut sebagai makula serulae.[2] Kutu ini dapat
dilihat dengan mata biasa dan susah untuk dilepaskan karena kepalanya dimasukkan ke
dalam muara folikel rambut.[2]

Gejala lainnya adalah black dot, yaitu bercak hitam yang tampak jelas pada celana dalam
berwarna putih yang terlihat saat bangun tidur.[2] Bercak hitam ini merupakan krusta
berasal dari darah yang sering diinterpretasikan salah sebagai hematuria.[2] Kadang-
¬kadang terjadi infeksi sekunder dengan pembesaran kelenjar getah bening regional.[2]

Pediculosis capitis adalah penyakit kulit kepala akibat infestasi

ektoparasit obligat (tungau/lice) spesies Pediculus humanus var. capitis
yang termasuk famili Pediculidae. Parasit ini termasuk parasit yang
menghisap darah (hemophagydea) dan menghabiskan seluruh siklus
hidupnya di manusia (Meinking & Buchart, 2008; Stone et al., 2012).
2.1.2 Epidemiologi

Penyakit pedikulosis kapitis dapat ditemukan di seluruh dunia pada

semua usia terutama pada anak-anak yang cenderung berusia 3-11
tahun. Negara Indonesia belum ada angka yang pasti mengenai
terjadinya infeksi Pediculosis capitis. Sedikit data yang bisa didapatkan
angka kejadian tersebut dinegara berkembang. Negara Malaysia sekitar
11% anak umur 3-11 tahun terinfeksi dan sekitar 40% di Taiwan. Sekitar
6 juta–12 juta estimasi anak kelompok umur 3-11 tahun yang terkena
penyakit tersebut di Amerika Serikat (Stone et al., 2012).

Pedikulosis kapitis bisa menginfeksi secara cepat dengan kontak

langsung maupun tidak langsung karena pada dasarnya kutu rambut
tidak bisa terbang maupun loncat. Penularan dapat berlangsung dengan
cepat pada lingkungan yang kurang baik ( Yulianti et al, 2014).

Morfologi
Penyakit pedikulosis kapitis dapat ditemukan di seluruh dunia pada
semua usia terutama pada anak-anak yang cenderung berusia 3-11
tahun. Negara Indonesia belum ada angka yang pasti mengenai
terjadinya infeksi Pediculosis capitis. Sedikit data yang bisa didapatkan
angka kejadian tersebut dinegara berkembang. Negara Malaysia sekitar
11% anak umur 3-11 tahun terinfeksi dan sekitar 40% di Taiwan. Sekitar
6 juta–12 juta estimasi anak kelompok umur 3-11 tahun yang terkena
penyakit tersebut di Amerika Serikat (Stone et al., 2012).

Pedikulosis kapitis bisa menginfeksi secara cepat dengan kontak

langsung maupun tidak langsung karena pada dasarnya kutu rambut
tidak bisa terbang maupun loncat. Penularan dapat berlangsung dengan
cepat pada lingkungan yang kurang baik ( Yulianti et al, 2014).
2.1.4 Siklus Hidup

Siklus hidup pedilukolis kapitis merupakan metamorfosis tidak sempurna

dimulai dari telur menjadi nimfa kemudian dewasa. Pedikulosis kapitis
membutuhkan waktu 18 hari mulai telur diletakkan sampai menjadi
dewasa. Telur akan menetas menjadi nimfa kurang lebih membutuhkan
waktu 10 hari dan pedikulosis kapitis dewasa dapat hidup selama 27 hari
(Fadilah, 2015).

Pedikulosis kapitis mampu bertahan hidup selama 1-2 hari apabila tidak
berada pada rambut atau kulit kepala manusia. Menurut Rahman (2014)
pedikulosis kapitis dapat bertahan hidup selama 48 jam tidak menghisap
darah apabila tidak berada di rambut atau kulit kepala manusia,
sedangkan telur sekitar 1 minggu apabila tidak terdapat dirambut atau
kulit kepala (Rahman, 2014).

Patogenesis

Pedikulosis kapitis merupakan parasit manusia yang menyerang pada

rambut bagian belakang kepala. Pedikulosis kapitis dapat berpindah dari
hospes yang satu ke hospes yang lain secara cepat. Pedikulosis kapitis
dapat bertahan hidup pada suhu 5°C selama 10 hari tanpa makan.
Pedikulosis kapitis mampu menghisap darah kepala dalam waktu yang
lama. Pedikulosis kapitis akan mati pada suhu 40°C. Sedangkan telur
pedikulosis kapitis dapat dimusnahkan pada suhu 60°C dalam waktu 15-
30 menit (Setiyo,2007). Factor pendukung penderita dapat terjangkit
pedikulosis kapitis adalah kurangnya menjaga kebersihan rambut dan
kebiasaan pinjam meminjam seperti pinjam meminjam sisir, topi, bantal,
kerudung dan handuk (Fadilah, 2015).

Pedikulosis kapitis akan menyebabkan rasa gatal, karena air liur yang
disuntikkan ke kulit kepala saat pedikulosis kapitis menghisap darah dan
kotoran yang diakibatkan oleh pedikulosis kapitis. Penderita akan
menggaruk kepala karena merasakan gatal. Kebiasaan menggaruk dapat
mengakibatkan luka, iritasi dan infeksi sekunder selain itu penderita
dapat mengalami anemia (Fadilah, 2015).
2.1.6 Faktor-faktor yang Mempengaruhi Kejadian Pediculosis capitis

Faktor-faktor yang diduga berperan serta dapat mempengaruhi

terjadinya Pediculosis capitis, antara lain :

1. Usia
Anak-anak lebih sering terkena penyakit Pediculosis capitis,
terutama kelompok umur 3-11 tahun (Meinking & Buckhart, 2008).
2. Jenis Kelamin
Menurut beberapa penelitian yang telah ada, anak perempuan
lebih sering terkena penyakit Pediculosis capitis. Hal ini dapat
dihubungkan bahwa anak perempuan hampir semuanya memiliki
rambut yang lebih panjang dari pada anak laki-laki. Anak
perempuanpun lebih sering menggunakan sisir dan aksesoris
rambut (Barbara et al., 2002).
3. Menggunakan Tempat Tidur atau bantal Bersama
Tungau dewasa dapat hidup di luar kulit kepala selama 1-2 hari,
sedangkan telurnya dapat bertahan sampai seminggu. Apabila
seseorang yang terkena infestasi Pediculus humanus var.capitis
dan meletakkan kepala disuatu tempat, maka kemungkinan besar
ada tungau dewasa serta telur yang terjatuh (Stone et al., 2012).
4. Menggunakan Sisir atau Aksesoris Rambut Bersama
Menggunakan sisir akan membuat telur bahkan tungau dewasa
menempel pada sisir tersebut. Apabila seseorang menggunakan
sisir yang ada tungau atau telur yang hidup maka akan tertular,
begitu juga dengan aksesoris rambut seperti kerudung, bando dan
pita (Natadistara & Ridad, 2009).
5. Panjang Rambut
Orang yang memiliki rambut panjang lebih sering terkena infestasi
Pediculosis capitis, hal ini disebabkan lebih susah membersihkan
rambut dan kulit kepala pada orang dengan rambut panjang
dibandingkan dengan rambut pendek (Meinking & Buckhart,
2008).

6. Frekuensi Cuci Rambut

Seringnya mencuci rambut berhubungan dengan tingkat

kebersihan rambut dan kulit kepala. Negara Amerika Serikat
dimana mencuci kepala adalah kebiasaan rutin sehari-hari, orang
yang terinfestasi Pediculosis capitis lebih sedikit, dibandingkan
dengan daerah dan negara yang masyarakatnya jarang mencuci
rambut (Barbara et al.,2002).

7. Ekonomi
Tingkat sosial ekonomi yang rendah merupakan resiko yang
signifikan dengan adanya infestasi tungau, selain itu juga
dikarenakan ketidak mampuan untuk mengobati infestasi secara
efektif (Barbara et al., 2002).
 8. Bentuk Rambut
Tungau dewasa betina susah untuk menaruh telur di rambut yang
keriting, maka dari itu orang afrika atau negro afrika-amerika
jarang yang terinfestasi kutu kepala (Meinking & Buckhart, 2008).

Gambaran Klinis

Lesi pada kulit kepala sering terjadi akibat tusukan pedikulosis kapits
saat menghisap darah dan sering ditemukan dibelakang leher atau
kepala (Natadisastra dan Agoes, 2009). Lesi akibat pedikulosis kapitis
berupa pupula urtikaria kecil, papula tersebut membentuk kelompok
yang yang terkadang ditutupi vesikel kecil yang terasa sangat gatal
(Fadilah, 2015). Gejala utama dari manifestasi tungau kepala ialah rasa
gatal, namun sebagian orang asimtomatik dan dapat sebagai karier.
Masa inkubasi sebelum terjadi gejala sekitar 4-6 minggu. Tungau dan
telur (nits) paling banyak terdapat didaerah oksipital kulit dan
retroaurikuler (Djuanda, 2007). Tungau dewasa dapat ditemukan dikulit
kepala berwarna kuning kecoklatan sampai putih keabu-abuan, tetapi
dapat berwarna hitam gelap bila tertutup oleh darah. Tungau akan
berwarna lebih gelap pada orang yang berambut gelap. Telur (nits)
berada di rambut dan berwarna kuning kecoklatan atau putih, tetapi
dapat berubah menjadi hitam gelap bila embrio di dalamnya mati (Stone
et al., 2012). Gigitan dari tungau dapat menghasilkan kelainan kulit
berupa eritema, makula dan papula, tetapi pemeriksa seringnya hanya
menemukan eritema dan ekskoriasi saja. Ada beberapa individu yang
mengeluh dan menunjukkan tanda demam serta pembesaran kelenjar
limfa setempat (Burn, 2004). Garukan pada kulit kepala dapat
menyebabkan terjadinya erosi, ekskoriasi dan infeksi sekunder berupa
pus dan krusta. Bila terjadi infeksi sekunder berat, rambut akan
bergumpal akibat banyaknya pus dan krusta. Keadaan ini disebut
plicapolonica yang dapat ditumbuhi jamur. Tungau kepala adalah
penyebab utama penyakit pioderma dikulit kepala di seluruh dunia
(Nutanson et al., 2008). 2.1.8 Diagnosis

Diagnosis pasti pada penyakit Pediculosis capitis adalah menemukan

Pediculus humanus var. capitis dewasa, nimfa, dan telur di kulit dan
rambut kepala. Telur (nits) sangat mudah dilihat dan merupakan marker
yang paling efisien dalam mendiagnosis penyakit tersebut (Djuanda,
2007). Apabila ditemukan telur bukanlah tanda infeksi aktif akan tetapi
tanda diagnostik infeksi apabila ditemukan telur 0,7 cm dari kulit kepala
(Rahman, 2014). Telur (nits) dapat dilihat dengan menggunakan kaca
pembesar dan dapat dijadikan patokan bahwa terinfeksi penyakit
pedikulosis kapitis. Penemuan pedikulosis kapitis merupakan tanda
bahwa sedang mengalami infeksi aktif, tetapi pedikulosis kapitis dewasa
sangat sulit ditemukan karena dapat bergerak dengan cepat sekitar 6-30
cm per menit dan bersifat menghindari cahaya. Sisir tungau dapat
membantu menemukan tungau dewasa maupun nimfa (Rahman, 2014).
Warna dari telur yang baru dikeluarkan adalah kuning kecoklatan. Telur
yang sudah lama berwarna putih dan jernih. Untuk membantu diagnosis,
dapat menggunakan pemeriksaan lampu wood. Telur dan tungau akan
memberikan fluoresensi warna kuning-hijau. Sangat penting untuk dapat
membedakan apakah telur tersebut kosong atau tidak. Adanya telur yang
kosong pada seluruh pemeriksaan memberikan gambaran positif palsu
adanya infeksi aktif tungau (Nutanson et al., 2008).

Penanganan Pedikulosis Kapitis

a. Pencegahan

Kutu kepala paling sering menyebar melalui hubungan langsung antar

kepala dari rambut kerambut. Meskipun demikian tungau dapat
menyebar melalui pakaian atau aksesoris kepala yang yang digunakan
secara bersama. Risiko untuk tertular melalui karpet atau tempat tidur
dimana tempat tungau jatuh sangatlah kecil. Kutu kepala dapat bertahan
kurang dari 1-2 hari jika mereka tidak berada dirambut dan tidak
mendapatkan makanan. Sedangkan telur dapat bertahan sekitar 1
minggu jika tidak berada dikelembapan dan temperatur yang sama
dengan kulit kepala dan rambut (Barbara et al., 2002). Berikut adalah
langkah– langkah yang dapat mencegah penyebaran penularan
Pediculosis capitis kepala:

1. Menghindari adanya kontak langsung rambut dengan rambut

ketika bermain

dan beraktivitas dirumah, sekolah, dan dimanapun.

2. Tidak menggunakan pakaian seperti topi, scarf, jaket, kerudung,

kostum

olahraga, ikat rambut secara bersamaan.

3. Tidak menggunakan sisir, sikat, handuk secara bersamaan.

Melakukan

desinfeksi sisir dan sikat dari orang yang terinfestasi dengan

direndam di air

panas sekitar 130F selama 5-10 menit.

4. Mencuci dan menjemur pakaian, perlengkapan tempat tidur,

karpet, dan lain-

lain.

5. Menyapu dan membersihkan lantai dan perabotan rumah tangga

lainnya

(CDC,2013).
b. Pengobatan

sedangkan pengobatan pedikulosis kapitis menurut Brown dan Burns

(2005) dapat menggunakan metode fisik dan metode kimiawi.
1. Metode Pengobatan Fisik

Metode pengobatan fisik yang sederhana antara lain adalah mencuci

rambut dengan shampoo, kemudian diikuti dengan penggunaan
kondisioner dalam jumlah yang banya. Rambut kemudian disisir
menggunakan serit (sisir yang giginya kecil-kecil dan rapat) dengan
tujuan agar semua kutu dapat terangkat. Tindakan ini dianjurkan
diulangi setiap 4 hari selama 2 mingu (Brown dan Burns, 2005).
Sedangkan menurut Natadisastra dan Agoes (2009) metode pengobatan
fisik kutu kepala dapat dilakukan dengan cara amaembunuh kutu dewasa
menggunakan tangan dan sisir serit untuk menyisir nimfa dan telurnya.
2. Metode Pengobatan Kimiawi

Menurut Behrman et al (2000) salah satu pengobatan pedikulosis kapitis

adalah dengan hexachlorocyclohexane atau sering disebut lindane.
Prinsip penggunaan shampoo lindane menurut Behrman et al (2000)
adalah:

a.

b. Menggunakan shampoo lindane 1% selama 10 menit dengan

pemberian berulang dalam 7-10 hari.
Seluruh anggota keluarga/penghuni tempat tinggal harus diterapi pada
waktu yang sama. Sedangkan menurut Wibowo(2009) lindane yang
digunakan yang untuk memberantas kutu kepala mempunyai kadar
kurang dari 1%. Behrman et al . (2000) dan Werner (2010) juga
menjelaskan bahwa untuk memberantas kantong telur yang melekat di
rambut adalah dengan menggunakan serit (sisir bergigi rapat) yang telah
di cuci dengan cuka yang dicampur air hangat dengan perbandingan 1:1
selama setengah jam. Pengendalian pedikulosis kapitis secara kimiawi
juga dapat menggunakan insektisida jenis pedikulosida lain seperti
malation, karbaril dan permetrin fenotrin yang telah secara luas dipakai
di seluruh dunia (Brown dan Burns, 2005).