Monday, March 2, 2015

Case of the Week 339

This week's case was generously donated by Dr. Mitre.

The patient is an 11 yo girl who reported scalp itching for several hours and expressed concern to her mother that she has lice since she borrowed a friend's hat earlier that day.  Examination that day showed several off-white particles about the size of a grain of sand stuck to her hair.  These were found scattered near the root of the hair as well as mid shaft and on the terminal ends. Of note, the girl shampoos and conditions her hair at least once a day, and then using a "frizz-free" foam when she brushes her hair.




From these photos, how would you counsel the patient and her parents?

6 comments:

Anonymous said...

These are not lice nits but may be excess shampoo or other hair-care substance. I am no Paul Mitchell, but I suggest less frequent shampooing and rinse hair well after using conditioner.

Anonymous said...

Excess hair care product not rinsed out probably irritating her scalp and making it itchy.

Anonymous said...

No Pediculus capitis or its ova found. Amorphous deposits possibly originating from hair care products observed. Discontinuation of hair care usage suggested.

Florida Fan

Arthur Morris said...

I cannot see any evidence of Pediculus sp. ova, looks to me to be non-parasitic in nature. Possibly down to her hair-care regime which could be causing contact dermatitis, this is somewhat out of my area of expertise but I would suggest changing it and see if that alleviates scalp irritation.

Anonymous said...

Black/White Piedra?? I will have to see if it is associated with hair care products...Lee

Anonymous said...

These aggregations are quite different than the nodules of Piedraia hortae, the agent of black piedra. Black piedra nodules are dark black, surrounding the hair shaft, and when crushed, we will see lunate ascospores inside transparent asci.
The aggregations are also different than those of white piedra caused by Trichosporon beigelii which infect mainly hairs of the beard or mustache.
The asymmetrical adhesions may mimic those of Tinea nodosa caused by Corynebacterium tenuis, however this coryneform infects mainly axilla hairs, hence the name trichomycosis axillaris.
I would rule out these possibities which are mostly mycotic and bacterial origins.

Florida Fan