What is Pediculosis Corporis?
Pediculosis corporis is a skin problem caused by body lice, tiny insects that bite to feed on our blood. There are three types of lice that feed on our blood: head lice, pubic or crab lice, and body lice. Entomologists, scientists who study insects, continue to discuss whether head and body lice should be considered as two separate species or one. Some believe they are two distinct species and refer to body lice as Pediculus humanus, while others view them as the same species and call them Pediculus humanus humanus. In medical textbooks and resources, body lice are often called Pediculus humanus corporis. Still, this is not the appropriate name according to the standards set by the International Commission on Zoological Nomenclature.
Scientific research has shown that head and body lice are closely related. Genetics show that there is only a single gene in body lice that can’t also be found in head lice.
However, it’s important to note the differences between body, head, and pubic lice. Unlike head and pubic lice, body lice don’t live on our skin. Instead, they make their home and lay their eggs in the seams of our clothing or bed linens, only coming to the skin when they need to feed. Another major difference is that body lice can spread certain bacterial diseases like trench fever, relapsing fever, and epidemic typhus, while head lice cannot.
What Causes Pediculosis Corporis?
Body lice are tiny creatures that live on the human body and feed on human blood to survive. Body lice can be found all around the world. They go through three stages in their life cycle, starting as an egg (also known as a nit), changing to a young lice (called a nymph), and finally becoming a full-grown adult lice.
Just like head lice, the eggs of body lice are oval and can look yellow or white. But unlike head lice which lay eggs in the seams of clothing, body lice lay their eggs near the root of body hairs. A nymph, or a young lice, looks just like an adult lice but is smaller in size. Adult lice have six legs, are tan to grayish-white, and are about the size of a small sesame seed. They don’t have wings and their bodies are flat.
Body lice need to feed on blood once to five times a day and can live up to 60 days. If they are away from a human, they will die within a week. Recent research has shown that people with serious iron deficiency anemia (a condition where you lack enough iron, which helps produce red blood cells) are more likely to get a lice infestation.
Risk Factors and Frequency for Pediculosis Corporis
Body lice cannot jump or fly, so they mainly spread through direct contact. However, they can also be transmitted through clothes, bed linens, and towels. Situations that favor the spread of body lice often involve poor body hygiene, lack of clean clothes and crowded living conditions. This is why you typically hear about lice outbreaks in places like prisons, war refugee camps, and homeless populations who don’t have access to clean clothes or showers. This doesn’t mean it only happens there, outbreaks have been reported all over the world, including rural areas in the Peruvian Andes and Russia, and also in jails and refugee camps in central and eastern Africa.
Signs and Symptoms of Pediculosis Corporis
If you spot signs like poor personal cleanliness, no access to clean clothes, homelessness, or living in crowded, dirty areas, these could be signs of a body lice infestation and related illnesses. The main symptom of body lice infestations is intense itching.
Skin changes from body lice infestation can differ. They may cause skin infections, red spots, hives, or bleeding dots. The intense itch from bites often leads to scratching, leading to sores and additional infections. Frequent bites in the same area over time can lead to the skin getting thick and discolored, a condition referred to as “vagabond’s disease”. Skin changes tend to be most visible in areas where clothes seams touch the skin, like the waist, groin, thighs, and armpit folds. Other symptoms may also be there, like swollen neck glands and eye inflammation.
- Poor personal cleanliness
- No access to clean clothes
- Homelessness
- Living in crowded, dirty areas
- Intense itching
- Skin infections
- Red spots
- Hives
- Bleeding dots
- Sores and additional infections from scratching bites
- Thick, discolored skin from frequent bites (vagabond’s disease)
- Swollen neck glands
- Eye inflammation
Unlike head and pubic lice, body lice are often diagnosed by finding eggs and lice in clothing seams rather than on the skin. Therefore, it’s important to thoroughly examine the clothes of patients suspected of having body lice. As well as lice, you might find indirect signs like blood stains or lice droppings.
Testing for Pediculosis Corporis
If you have an infestation of body lice, they’re sometimes noticed moving on your skin. But usually, the infestation is confirmed when eggs and lice are found in the seams of your clothes. There’s a specific lab test available, known as PCR assay, that can tell the difference between head lice and body lice. However, this test is mainly used for research and isn’t typically used to guide treatment decisions in the clinic.
Treatment Options for Pediculosis Corporis
Treating body lice usually doesn’t require the use of a special lice-killing medicine, also known as a pediculicide, because improved hygiene can often get rid of the infestation. This includes showering and washing your clothing, bedding, and towels in hot water (at least 50 °C) and drying them on a hot cycle in a machine.
If body lice are causing you to itch, you can use topical corticosteroids, which are creams or ointments applied to the skin, and antihistamines, which are usually taken by mouth, for relief. If the itching has caused infections on the skin, antibiotics, which are medicines to treat infections caused by bacteria, may be necessary.
While special lice-killing medicines aren’t usually needed to get rid of body lice infections, they are often used if body lice or eggs are found on body hair or if the person is also infected with head lice, pubic lice, or scabies. In these cases, treatments can include the same medicines used for pubic and head lice, most commonly permethrin cream which is applied all over the body for 8 to 10 hours. Other possible treatments include benzyl alcohol lotion, ivermectin lotion, malathion lotion, spinosad topical suspension, and lindane shampoo.
Lindane shampoo is not recommended as the first choice for treatment because it can sometimes cause serious reactions, like problems with the nervous system and seizures. In instances with large numbers of people, like refugee camps, using chemical insecticides in the environment may sometimes be necessary to prevent the spread of body lice and the diseases they can carry.
What else can Pediculosis Corporis be?
When examining a skin condition caused by body lice, doctors also consider other potential causes. These can include:
- Scabies
- Contact dermatitis
- Atopic dermatitis
- Drug reactions
- Viral rashes (also known as viral exanthem)
It’s also common to find co-infections, especially among refugee populations, with:
- Head lice
- Pubic lice
- Scabies
- Fleas
Body lice can sometimes cause serious diseases like trench fever, relapsing fever, and epidemic typhus, especially when symptoms of full-body infection are present. Diseases that present with similar symptoms, and therefore may also be considered by doctors, include:
- Babesiosis
- Brucellosis
- Q fever
- Typhoid fever
- Leptospirosis
- Ehrlichiosis
- Tularemia
What to expect with Pediculosis Corporis
The chances of getting rid of a body lice infestation are excellent if people shower regularly and have access to clean clothing and bedding every week. Diseases carried by lice can cause serious health issues and even death, but these risks can be significantly lowered by noticing the signs early and getting the right antibiotic treatment.
Epidemic typhus is one disease carried by lice that can cause damage to blood vessels, leading to reduced blood flow to limbs, tissue death, dysfunction in the brain and nervous system, and failure of multiple organs. The death rate for untreated patients can be between 20% and 40%, but this falls to around 3% to 4% with the right antibiotic treatment.
Relapsing fever also carried by lice has a death rate of about 40% if it isn’t treated, but this rate falls to around 4% with treatment.
Trench fever, caused by a bacteria called B. quintana, usually resolves itself in people with a healthy immune system. However, it can result in endocarditis, a potentially life-threatening inflammation of the inner lining of the heart. This can increase the risk of serious health issues and death.
Possible Complications When Diagnosed with Pediculosis Corporis
Body lice infestation usually doesn’t cause serious problems, but it can lead to some negative and secondary issues. So, let’s look at some possible complications of having body lice:
- Secondary Bacterial Infections: If you scratch the itchy areas too much, you might break your skin and give bacteria a way in. This can cause secondary bacterial infections like impetigo or cellulitis, which can result in red, swollen, pus-filled bumps on your skin.
- Prurigo Nodularis: Constant scratching can cause prurigo nodularis, a skin condition with itchy bumps. These bumps can last a long time and might need treatment from a doctor.
- Excoriations and Dermatitis: If you scratch because of the itchiness, you can wound your skin and cause dermatitis. If you keep scratching, it can make the inflammation worse and result in bigger skin problems.
- Psychological Distress: Having body lice for a long time and the itchiness it causes can lead to significant emotional distress, causing stress, anxiety, or depression. Being embarrassed or feeling stigmatized can also add to these mental health complications.
- Complications in Vulnerable People: If you’re already a vulnerable person, like if you have a weakened immune system, are an older adult, or live in crowded or unsanitary conditions, you might have more severe symptoms. In these situations, body lice can lead to more severe complications.
- Transmission of Pathogens: While body lice themselves don’t directly spread diseases, they can play a role in spreading certain bacterial pathogens. Body lice have been linked to spreading diseases like trench fever, typhus, and relapsing fever, which are more common in conditions of poor hygiene and overcrowding.
- Anemia: In extreme cases, with a long-term and severe body lice infestation, you could lose enough blood from repeated lice feedings to cause anemia. However, this is a rare complication.
Preventing Pediculosis Corporis
If you don’t regularly wash yourself and your clothes, or if you live in a crowded environment, you’re more likely to get an infestation. These are conditions where a large number of organisms invade and harm the body. This often happens when lots of people live in unsanitary places, like prisons or refugee camps caused by war, famine, or natural disasters. So, it’s very important to keep clean and not share clothes or personal items to prevent these infestations.
