Scalp infestation by Pthirus pubis in a 91-year-old woman: A rare cause of chronic scalp pruritus
Abstract
Pthirus pubis is an ectoparasite that typically infests pubic hair and is primarily transmitted through close sexual contact. Although extragenital involvement may occur, scalp infestation remains exceptionally uncommon. We report the case of a 91-year-old woman who presented with a two-month history of persistent scalp pruritus that failed to respond to oral terbinafine and ketoconazole shampoo. Dermatological examination revealed numerous adult lice and nits attached to scalp hairs, with additional involvement of the eyelashes, eyebrows, and pubic region. Microscopic examination confirmed Pthirus pubis infestation. Screening for sexually transmitted infections was negative. Treatment with topical permethrin combined with oral ivermectin led to complete clinical and parasitological resolution. This case highlights the importance of considering Pthirus pubis in the differential diagnosis of chronic scalp pruritus, even in very elderly patients. Careful examination of all hair-bearing areas is essential to establish an early diagnosis and avoid inappropriate treatment.
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BibTeX
@article{etheve2026scalp,
title = {{Scalp infestation by Pthirus pubis in a 91-year-old woman: A rare cause of chronic scalp pruritus}},
author = {Floriane Etheve and Estelle Perraud and Damien Boutin},
journal = {IDCases},
year = {2026},
month = sep,
doi = {10.1016/j.idcr.2026.e02788},
url = {https://hal.science/hal-05857788v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Scalp infestation by Pthirus pubis in a 91-year-old woman: A rare cause of chronic scalp pruritus
AU - Floriane Etheve
AU - Estelle Perraud
AU - Damien Boutin
PY - 2026
DA - 2026/09/28
JO - IDCases
DO - 10.1016/j.idcr.2026.e02788
UR - https://hal.science/hal-05857788v1
AB - Pthirus pubis is an ectoparasite that typically infests pubic hair and is primarily transmitted through close sexual contact. Although extragenital involvement may occur, scalp infestation remains exceptionally uncommon. We report the case of a 91-year-old woman who presented with a two-month history of persistent scalp pruritus that failed to respond to oral terbinafine and ketoconazole shampoo. Dermatological examination revealed numerous adult lice and nits attached to scalp hairs, with additional involvement of the eyelashes, eyebrows, and pubic region. Microscopic examination confirmed Pthirus pubis infestation. Screening for sexually transmitted infections was negative. Treatment with topical permethrin combined with oral ivermectin led to complete clinical and parasitological resolution. This case highlights the importance of considering Pthirus pubis in the differential diagnosis of chronic scalp pruritus, even in very elderly patients. Careful examination of all hair-bearing areas is essential to establish an early diagnosis and avoid inappropriate treatment.
SN - 2214-2509
ER -