Crusts on the Eyelashes

Muriel Ouedraogo (1) , Sarah Ventejou (1) , Sophie Leducq (2) , Guillaume Desoubeaux (1, 3) , Annabel Maruani (4)

1 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
2 Service de dermatologie (CHRU de Tours)
3 CEPR - Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100
4 LTCI - Laboratoire Traitement et Communication de l'Information

A 27-month-old boy was referred to pediatric dermatology for the evaluation of crusts on his eyelashes; they had been present for 2 months and were increasing in number. The crusts had appeared after a trip to Bulgaria, where his family had been sleeping in several different hotels and places. Physical examination showed crusts on both eyelashes and a few crusts on the front part of his scalp. He had slight conjunctivitis and palpebral pruri-tis. The child was in good health and the physical examination was otherwise normal. His weight was 13.5 kg. Findings of a dermoscopy examination revealed that the crusts actually consisted of agglomerates of nits on the prox-imal side of the eyelashes, and several parasites were visible (Figure). There were a few parasites on the front part of his scalp hair also. The hair on his father's chest had several nits. Parasitology examination revealed that the parasites were Phtirus pubis. The child and his parents were given oral ivermectin 400 mg/kg (day 1 and day 7) and topical ophthalmologic rifamycin ointment once a day for 7 days, along with manual removal of the nits and parasites. Complete remission was obtained after 3 weeks of treatment. After interrogation, we concluded that phthiriasis had been transmitted from the father's chest to the child, who used to sleep on the chest of his parents. Phthiriasis palpebrarum is very uncommon in children, especially infants. It can reach the eyelashes but also can extend to the hair and might be complicated by conjunctivitis by an irritative mechanism. 1,2 The clinical diagnosis is confirmed by parasitology examination. The treatment usually consists of mechanical (manual or with tweezers) removal of nits and parasites using petrolatum. In our case, ophthalmologic rifamycin ointment was used to treat the conjunctivitis and facilitated manual removal. We added ivermectin treatment with the dosage recommended for difficult-to-treat head lice, 3,4 which is greater than that for scabies. Phthiriasis in children must always raise the question of the contamination method, which in children is secondary to contact with an infested adult. The origins of this infection need to be carefully discerned, and the question of sexual abuse must be raised. 5 n

Domaines: Maladies infectieuses; Sciences du Vivant [q-bio]; Mycologie; Parasitologie

Muriel Ouedraogo, Sarah Ventejou, Sophie Leducq, Guillaume Desoubeaux, Annabel Maruani. Crusts on the Eyelashes. J Pediatr, 2019, ⟨10.1016/j.jpeds.2019.02.002⟩. ⟨hal-02443905⟩