PEDICULOSIS CORPORIS

Synonyms.—Pediculosis vestimenti seu vestimentorum; Phthiriasis corporis;
Vagabond’s disease; Fr., Phtiriase du corps.

Pediculosis corporis, or body-lousiness, is due to the presence of the
pediculus corporis. It is characterized by more or less general itching,
excoriations, together with various inflammatory lesions, some of which
may be primary and others secondary. In sensitive skin wheals, usually
of evanescent character, sometimes arise at the points where the parasites
have inserted their sucking apparatus, or haustellum. This act also
produces a peculiar lesion, which may be said to be characteristic,
consisting of a minute hemorrhagic punctum on a level with the surface
and practically imperceptible to the finger passing over it—in this respect
differing from the red, excoriated points resulting from scratched, con­
gested, or irritated follicles. As the parasites live in the clothing, in
the seams, and also where the skin is most conveniently reached for pur­
poses of feeding, the various lesions and excoriations are, therefore,
to be found most abundantly on those parts with which the clothing
comes closely in contact, as, for instance, around the neck, across the
shoulders and upper part of the back, around the waist, over the sacrum,
and down the outside of the thighs. The parasites, if numerous, are
readily found, but if in scanty number are to be hunted for in the seams
of the collar-band; the ova are also found in the clothing, and sometimes
attached to the lanugo hairs, especially of the upper part of the trunk.
The irritation produced is often sufficiently intense in this form to lead
to more or less violent scratching, so that it is not uncommon to see,
here and there, but especially upon the upper part of the back, parallel
linear scratch-marks made by several or more of the finger-nails, in efforts
to gain relief. The continued irritation, consequent hyperemia, and the
excoriations occasionally bring about in places a slight degree of eczema,
and also in persistent cases a variable degree of resulting pigmentation,
most pronounced on the upper portion of the trunk posteriorly, although
in extreme instances it is more or less general and of quite a dark hue, as
to suggest the possibility of Addison’s disease (see under Chloasma).¹

¹ The observations of Besnier, Greenhow, and Thibiérge (Thibiérge, Bull, et mêm.
de la Soc. méd. des hôp. de Paris, Dec 18, 1891) that in some of these instances pigmen­
tation is also found on the buccal mucous membrane, and also on the glans penis, would
seem to indicate that there were other reasons for the integumentary discoloration in
addition to those commonly believed. Thibiérge remarks that such cases reduce the
pathognomonic significance of pigmentation of the mucous membranes in Addison’s
disease.

1178                          PARASITIC AFFECTIONS

The violence with which the skin is sometimes scratched is such that
the nails not only penetrate to the corium, but into some depth of the
latter, as shown here and there, especially on the back, by scattered,
small, irregular, atrophic-looking, or cicatricial spots. These are also
to some extent possibly due to the secondary ecthymatous lesions which
are occasionally seen. The symptoms vary considerably, however, in
different individuals, in some the itching being extremely slight and the
effects insignificant, in others of a decided, scarcely bearable character,
the patients getting but little rest, and the skin the seat of papules, small
and large pustules, and excoriations. Jamieson¹ has recorded a few
instances of pyrexia, apparently of reflex nature, due to the presence of
body-lice, and in cases in which the cutaneous lesions were insignificant.
Pediculosis corporis is commonly seen in adults, and more frequently
in those of advancing years. It is rather rare in children. It is observed
quite often among the frequenters of lodging-houses and among the cach­
ectic, poor, and uncared-for. Certain individuals are more prone to
successful invasion than others. It is readily communicated by trans­
ference of either the parasites or their ova.

The diagnosis of pediculosis corporis in well-marked examples
is comparatively easy, as the distribution of the excoriations and other
lesions, as well as often the pigmentation and the usually intense itchi-
ness, and the minute hemorrhagic puncta, are quite suggestive. Parallel
linear scratch-marks are also, as a rule, significant. The distribution
and absence of hand involvement are generally sufficient to prevent
error with scabies (see the latter for other differential points). Careful
search will almost invariably disclose one or more pediculi, unless the
underwear had been changed just before examination, and in some in­
stances ova can be found attached to the lanugo and other body-hairs.
In some cases there is a suggestion of urticaria, the wheals arising where
the pediculi have inserted the haustellum, as well as sometimes elsewhere
in consequence of the reflex irritation. The distribution, however, as
well as the other characters mentioned, will generally suffice for the dif­
ferentiation. In ordinary urticaria the hands and face frequently share
in the eruption, parts not involved in pediculosis. The malady is not
to be confused with simple pruritus (q. v.).

Treatment.—As the lice only go to the skin for the purpose of
feeding, the main attention in the treatment of pediculosis corporis is
to be directed to the infested wearing apparel and bed-linen, which
should be thoroughly baked, boiled, or gone over with a very hot iron
in order to destroy the pediculi and their ova. Inasmuch, however, as
in some instances the ova are found attached to the lanugo body-hairs,
a fact to which Jamieson² has directed notice, the surface, therefore,
requires treatment also, otherwise a recurrence naturally soon shows
itself. An occasional general tub-bath of corrosive sublimate (3ij-iij
(4.-12.) to the bath), if there are not many excoriations, will be destruc­
tive to the ova. The employment of a naphthol-sulphur soap in con-

¹ Jamieson, “On Some of the Rarer Effects of Pediculi,” Brit. Jour. Derm., 1889,
p. 321.

² Jamieson, ibid., 1895, p. 248.

PEDICULOSIS

1179

nection with the ordinary bath is also serviceable. Jamieson advises
the use of a piece of roll sulphur, the size of a pigeon’s egg, in a coarse
muslin or canvas bag, and worn next the skin day and night; the heat of
the body causes gradual oxidation and the formation of sulphurous acid.
This plan can, as Jamieson suggests, also be employed in those of the
careless or tramp class, who cannot give proper attention to the apparel.
In these instances, too, the use of an ointment of stavesacre, 2 drams
(8.) to the ounce (32.), of sulphur, 30 to 60 grains (2.-4.) to the ounce
(32.), or of B-naphthol, 20 to 60 grains (1.33-4.) to the ounce (32.),
will serve a like purpose. These ointments, if in weaker strengths, also
are of benefit to the papular and pustular lesions; but if the skin is
decidedly eczematous, a weak carbolized zinc ointment or a saturated
solution of boric acid, with 1 or 2 drams (4.-8.) of carbolic acid to the
pint (500.), is to be preferred. Carbolic acid, like the other substances
named, is likewise distasteful to the parasites.

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